Provider Demographics
NPI:1447239108
Name:WILLIAMS, KENNETH BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BRIAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:K
Other - Middle Name:BRIAN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-306-0395
Mailing Address - Fax:330-856-5887
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-306-0395
Practice Address - Fax:330-856-5887
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3579-W207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000174101OtherUNISON ADVANTAGE
OH0675676Medicaid
OH341568332-00OtherBWC
OH127925100OtherDEPT OF LABOR
OH000000134193OtherANTHEM
OH0901144OtherAETNA
OH1369579OtherUMWA
OH000000134193OtherANTHEM
OH127925100OtherDEPT OF LABOR
OH0901144OtherAETNA