Healthcare Provider Details

I. General information

NPI: 1366355067
Provider Name (Legal Business Name): MATTHEW WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 E 38TH ST
INDIANAPOLIS IN
46226-5614
US

IV. Provider business mailing address

328 E WALNUT ST
INDIANAPOLIS IN
46202-3360
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-6002
  • Fax:
Mailing address:
  • Phone: 317-440-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28269932A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: