Provider Demographics
NPI:1568401180
Name:WILLIAMS, NICHOLAS R (DPM)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40520 COUNTY HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9612
Mailing Address - Country:US
Mailing Address - Phone:218-983-4300
Mailing Address - Fax:218-983-6360
Practice Address - Street 1:40520 COUNTY HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9612
Practice Address - Country:US
Practice Address - Phone:218-983-4300
Practice Address - Fax:218-983-6360
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN572213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN14222OtherNDBS #
MN2700190OtherMEDICA #
MN14162OtherNDBS #
MN35T29WIOtherMNBS #
MN36T29WIOtherMNBS #
MN18906Medicaid
MN619725600Medicaid
MN36T28WIOtherMNBS #
MN915962OtherARAZ #
MNHP38916OtherHEALTHPARTNERS #
MNMN200019OtherLHS/BANNERHEALTH #
MN137085OtherUCARE #
MNDA9031015672OtherPREFERRED ONE #
MNMN200019OtherLHS/BANNERHEALTH #
MNDA9031015672OtherPREFERRED ONE #
MN915962OtherARAZ #
MN36T28WIOtherMNBS #
MNT60097Medicare UPIN
MN18906Medicaid
MN619725600Medicaid