Provider Demographics
NPI:1053396549
Name:MAC WILLIAMS, GRISEL (MD)
Entity type:Individual
Prefix:DR
First Name:GRISEL
Middle Name:
Last Name:MAC WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E 39 PL.
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-691-7018
Mailing Address - Fax:305-691-5814
Practice Address - Street 1:810 E 39TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2863
Practice Address - Country:US
Practice Address - Phone:305-691-7018
Practice Address - Fax:305-691-5814
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045706174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047895400Medicaid
FLD82307Medicare UPIN
FL02205Medicare PIN