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General NPI Number Information
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NPI Number | 1417766742
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Entity Type | Organization
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Legal Business Name | WILLIAMS PERSONALIZED CARE LLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 2525 SOUTH ST STE A
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City | LAFAYETTE
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State | IN
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Zip | 47904-3028
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Country | US
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Telephone | 765-807-2320
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Fax | 765-807-2330
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Provider Business Mailing Address
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Address Line | 3200 SOUTH ST UNIT 3
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City | LAFAYETTE
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State | IN
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Zip | 47904-3185
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Country | US
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Telephone | 765-366-5776
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Fax | 765-807-2330
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MARK HENRY WILLIAMS
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Credential | MD
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Telephone | 765-807-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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