Provider Demographics
NPI:1689705287
Name:WILLIAMS, DAVID CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CRAIG
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3660 GUION RD
Practice Address - Street 2:STE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1616
Practice Address - Country:US
Practice Address - Phone:317-920-7139
Practice Address - Fax:317-920-7229
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000773A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350580AMedicaid
INP01405415OtherRAILROAD MEDICARE
IN000000703092OtherANTHEM
INP00960530OtherRRMEDICARE
INM400047275Medicare PIN
IN266180471Medicare PIN
INP01405415OtherRAILROAD MEDICARE