Provider Demographics
NPI:1194990077
Name:WILLIAMS, MITCHELL N (DPM)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 COIT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5955
Mailing Address - Country:US
Mailing Address - Phone:972-316-0902
Mailing Address - Fax:
Practice Address - Street 1:502 N VALLEY PKWY STE 2
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067
Practice Address - Country:US
Practice Address - Phone:972-316-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO679213ES0103X
TX1852213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1194990077OtherRAILROAD MEDICARE
CO1720207863OtherNPIGROUP
CO22572589Medicaid
CO1194990077OtherNPI
CO22572589Medicaid
CO1720207863OtherNPIGROUP