Basic Information
| Provider Information | |||||||||
| NPI: | 1508809252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133890 | ||||||||
| FaxNumber: | 5179133891 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 IDAHO ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835011965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087437427 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 4301030881 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | MC-0528 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1000914 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 900002953 | 01 | MI | RAILROAD MEDICARE | OTHER | 1103300241 | 01 | MI | BCBS/BCN | OTHER | 1103300241 | 01 | MI | HEALTHPLUS OF MICHIGAN | OTHER | 200000001034 | 01 | MI | PHP FAMILYCARE | OTHER | 0M76680001 | 01 | MI | MEDICARE ADVANTAGE | OTHER | 1000914 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 200000001034 | 01 | MI | PHP | OTHER | 3454811 | 05 | MI | MEDICAID | 4062823 | 01 | MI | AETNA | OTHER | 104833738 | 05 | MI | MEDICAID | 3454830 | 05 | MI | MEDICAID | 1000914 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER |