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Individual

DR. WILLIAM LISTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1040
(906) 483-1043
Mailing address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1040
(906) 483-1043

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MI51012076
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0829560001
MEDICARE DME
MI
01
0C16002
MEDICARE GROUP
MI
05
114387150
MI
01
WL012076
BLUECROSS STATE ID
MI
Enumeration date
05/08/2006
Last updated
11/24/2009
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