MEDICARE: CARLA M WILLIAMS M.D.

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	207VG0400X	Gynecology Physician	7830	MT
2	207VG0400X	Gynecology Physician	MD60100971	WA
3	207V00000X	Obstetrics & Gynecology Physician	53569-20	WI

General Provider Information

NPI Number	:	1235266503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA M WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	715-838-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 BELLINGER ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703
Country	:	US
Telephone Number	:	715-838-5222
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	12/04/2020

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