Provider Demographics
NPI:1891338042
Name:LOUIS, WILLEM
Entity Type:Individual
Prefix:
First Name:WILLEM
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 N JEFFERSON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3941
Mailing Address - Country:US
Mailing Address - Phone:816-518-2607
Mailing Address - Fax:
Practice Address - Street 1:6114 N JEFFERSON ST APT 4
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3941
Practice Address - Country:US
Practice Address - Phone:816-518-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1721728128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health