Healthcare Provider Details

I. General information

NPI: 1609797398
Provider Name (Legal Business Name): MICHAEL LUKE WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL LUKE

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HAMPTON AVE STE 200
SAINT LOUIS MO
63139-3163
US

IV. Provider business mailing address

4043 CLEVELAND AVE APT 1E
SAINT LOUIS MO
63110-3988
US

V. Phone/Fax

Practice location:
  • Phone: 314-970-2544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: