MEDICARE: LAMONT TERRANCE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	W452-5387-2415-07	WI

General Provider Information

NPI Number	:	1184981235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAMONT TERRANCE WILLIAMS

Provider Business Mailing Address
First Line	:	5129 W VIENNA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2312
Country	:	US
Telephone Number	:	414-803-4976
Fax Number	:

Provider Business Practice Location Address
First Line	:	5129 W VIENNA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2312
Country	:	US
Telephone Number	:	414-803-4976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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