Healthcare Provider Details

I. General information

NPI: 1184291817
Provider Name (Legal Business Name): LOYAL DEAN WILLIAMS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: L. DEAN WILLIAMS II MD

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7588 GARRICK ST
FISHERS IN
46038-1923
US

IV. Provider business mailing address

7588 GARRICK ST
FISHERS IN
46038-1923
US

V. Phone/Fax

Practice location:
  • Phone: 815-238-0536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01088272A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11021589A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: