Provider Demographics
NPI:1942296959
Name:WILLIAMS, ANDRE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:M
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:PO BOX 511269
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1269
Mailing Address - Country:US
Mailing Address - Phone:941-639-0025
Mailing Address - Fax:941-347-7271
Practice Address - Street 1:352 MILUS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4552
Practice Address - Country:US
Practice Address - Phone:941-639-0025
Practice Address - Fax:941-374-7271
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3153213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340579600Medicaid
POP291370OtherRAILROAD MEDICARE PTAN
FL65916OtherBLUE SHIELD
POP291370OtherRAILROAD MEDICARE PTAN
FLU5763YMedicare ID - Type Unspecified
0458500001Medicare NSC
FL340579600Medicaid