Provider Demographics
NPI:1003971490
Name:WILLIAMS, CARL MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:MARC
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MINISTRY PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5220
Mailing Address - Country:US
Mailing Address - Phone:715-393-1000
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1672
Practice Address - Country:US
Practice Address - Phone:260-373-9700
Practice Address - Fax:260-373-9740
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016380207RC0200X, 207RP1001X
PAMD434996207RC0200X, 207RP1001X
WI60181-20207RC0200X, 207RP1001X
IN01064129A207RC0200X, 207RP1001X
WI60181207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2051760OtherHIGHMARK BLUE SHIELD
IN200869120Medicaid
WI1003971490Medicaid
PA1021751160001Medicaid
IN000000528048OtherANTHEM PROVIDER NUMBER
PA823273OtherFIRST PRIORITY HEALTH
INPENDINGOtherPHCS PID NUMBER
INPENDINGOtherPHCS PID NUMBER
MEG86977Medicare UPIN
IN815490AAAAMedicare PIN
IN815450HHMedicare PIN
IN224390CCMedicare PIN