Individual
DR. RUSSELL G WILLIAMS
Active
Individual
DR. RUSSELL G WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5101016594
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E16001
MEDICARE GROUP PTAN
MI
05
—
4782586
—
MI
01
—
E16001022
MEDICARE PTAN
MI
01
—
RW016594
STATE LICENSE NUMBER
MI
Enumeration date
01/06/2007
Last updated
07/06/2009
Update your record
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