Provider Demographics
NPI:1366581209
Name:WILLIAMSON, MICHAEL J (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:REID HOSPITAL & HEALTH CARE SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8773
Mailing Address - Fax:765-935-8774
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:REID HOSPITAL & HEALTH CARE SERVICES
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-935-8773
Practice Address - Fax:765-935-8774
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002568A207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00411731OtherMEDICARE B-RAILROAD
IN200469280Medicaid
INP01014252OtherRR MEDICARE
IN200469280Medicaid
INP01014252OtherRR MEDICARE