Provider Demographics
NPI:1205845252
Name:NETTEY, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:NETTEY
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 1:220 S NORTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3200
Mailing Address - Country:US
Mailing Address - Phone:765-573-6656
Mailing Address - Fax:765-573-6659
Practice Address - Street 1:220 S. NORTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3200
Practice Address - Country:US
Practice Address - Phone:765-573-6656
Practice Address - Fax:765-573-6659
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048532207L00000X
IN01048532A207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200191360Medicaid
IN169130DDMedicare PIN
IN200191360Medicaid
ININ2421Medicare PIN