Provider Demographics
NPI:1295737229
Name:MACINNES, WILLIAM DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:MACINNES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4705 TOWNE CENTRE RD
Mailing Address - Street 2:STE 304
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2821
Mailing Address - Country:US
Mailing Address - Phone:989-921-5100
Mailing Address - Fax:989-921-5104
Practice Address - Street 1:4705 TOWNE CENTRE RD
Practice Address - Street 2:STE 304
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2821
Practice Address - Country:US
Practice Address - Phone:989-921-5100
Practice Address - Fax:989-921-5104
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008040103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680G345240OtherBCBSM
MIWM008040Medicare UPIN
MI0N39620Medicare ID - Type Unspecified