Provider Demographics
NPI:1821006032
Name:MARK WILLIAMS M.D., LLC
Entity Type:Organization
Organization Name:MARK WILLIAMS M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-244-9355
Mailing Address - Street 1:PO BOX 436256
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-6256
Mailing Address - Country:US
Mailing Address - Phone:502-244-9355
Mailing Address - Fax:502-244-9577
Practice Address - Street 1:12010 SHELBYVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1054
Practice Address - Country:US
Practice Address - Phone:502-244-9355
Practice Address - Fax:502-244-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000334878OtherANTHEM PROVIDER ID
5931697OtherAETNA PROVIDER ID
KYP00202037OtherRAILROAD MEDICARE ID
KYH10999OtherUPIN
5931697OtherAETNA PROVIDER ID