Provider Demographics
NPI:1518044353
Name:WILLIAMS, SHERON R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERON
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE G1-11
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-8121
Practice Address - Fax:502-636-8128
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25238207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50104168OtherPASSPORT - NCMA
KY50016305OtherPASSPORT
KY64252380Medicaid
IN200092790BMedicaid
KY009314OtherSIHO - NCMA
KY000000801698OtherANTHEM - NCMA
KY009314OtherSIHO - NCMA
KYK190980Medicare PIN
KYE73942Medicare UPIN
KY50016305OtherPASSPORT
IN630960MMedicare PIN