Basic Information
| Provider Information | |||||||||
| NPI: | 1689780009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LOUIE | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E BROADWAY | ||||||||
| Address2: | SUITE 185C | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295455 | ||||||||
| FaxNumber: | 5026294151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 01041323 | IN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 26921 | KY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 083432 | 01 | SIHO - NREHABPHYS | OTHER | 64269210 | 05 | KY | MEDICAID | P00451544 | 01 | IN | RAILROAD MEDICARE | OTHER | 100383190 | 05 | IN | MEDICAID | P00451616 | 01 | KY | RAILROAD MEDICARE | OTHER | 50013453 | 01 | PASSPORT - NREHABPHYS | OTHER | 000000509322 | 01 | ANTHEM - NREHABPHYS | OTHER |