Basic Information
| Provider Information | |||||||||
| NPI: | 1992791453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMOTS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Practice Location | |||||||||
| Address1: | 8765 LEWIS AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPERANCE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481829583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348473802 | ||||||||
| FaxNumber: | 7348500520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 06/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301035215 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4783547 | 05 | MI | MEDICAID | 03634 | 01 | PARAMOUNT | OTHER | 396443925-001 | 01 | MMO | OTHER | 4220274 | 01 | AETNA | OTHER | 0804641971 | 01 | BCBS MI | OTHER | 000000387441 | 01 | ANTHEM | OTHER | 113277 | 01 | CARECHOICES/PREFERRED CHO | OTHER | P00254442 | 01 | RRMC | OTHER | E86031 | 01 | MI | BCBS OF MICHIGAN | OTHER |