Individual
DR. RUSSELL G WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
395 3RD ST, MANISTEE, MI 49660-1718
(877) 398-2013
Mailing address
310 GLOCHESKI DR, MANISTEE, MI 49660-2639
(877) 398-2013
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
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