Provider Demographics
NPI:1689780009
Name:WILLIAMS, LOUIE N (MD)
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:N
Last Name:WILLIAMS
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: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 1:315 E BROADWAY
Practice Address - Street 2:SUITE 185C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-629-5455
Practice Address - Fax:502-629-4151
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041323208100000X
KY26921208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
083432OtherSIHO - NREHABPHYS
KY64269210Medicaid
INP00451544OtherRAILROAD MEDICARE
IN100383190Medicaid
KYP00451616OtherRAILROAD MEDICARE
50013453OtherPASSPORT - NREHABPHYS
000000509322OtherANTHEM - NREHABPHYS
000000509322OtherANTHEM - NREHABPHYS
50013453OtherPASSPORT - NREHABPHYS
E63916Medicare UPIN