Willie James Pettiway Sr., MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301049323 Issued in MI

Practice address

8251 W 8 Mile Rd
Detroit, MI 48221

Phone

(313) 966-3300

NPI assigned

Feb 26, 2007

Last updated

Jul 20, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Medical Center PC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1659520237
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1275669293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8251 W 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482211195",
            "telephone_number": "313-345-8120",
            "fax_number": "313-340-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8251 W 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48221",
            "telephone_number": "313-966-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIWAY",
        "first_name": "WILLIE",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301049323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanise Yvonne Petticord
• Karen Pettiford
• Roshelle Deshawn Pettiford
• Rebecca Pettinger, LLPC
• Valerie Pettis
• Joyya Pettus, CERTIFIED PEER SPEC
• Barbara Anne Pettway
• Carl Pettway Jr., LLMSW
• Gwendolyn Lenette Pettway, LPC
• Nicole Theodora Pettway, LPN

• Internal Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.