Provider Demographics
NPI:1992791453
Name:DEMOTS, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:DEMOTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:777 KIMOLE LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1478
Mailing Address - Country:US
Mailing Address - Phone:517-263-5655
Mailing Address - Fax:517-263-8012
Practice Address - Street 1:8765 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9583
Practice Address - Country:US
Practice Address - Phone:734-847-3802
Practice Address - Fax:734-850-0520
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4783547Medicaid
03634OtherPARAMOUNT
396443925-001OtherMMO
4220274OtherAETNA
0804641971OtherBCBS MI
000000387441OtherANTHEM
113277OtherCARECHOICES/PREFERRED CHO
P00254442OtherRRMC
MIE86031OtherBCBS OF MICHIGAN
4220274OtherAETNA
MIM35150031Medicare PIN
MIE86031017Medicare PIN