Provider Demographics
NPI:1184291817
Name:WILLIAMS, LOYAL DEAN II (MD)
Entity type:Individual
Prefix:DR
First Name:LOYAL
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:DEAN
Other - Last Name:WILLIAMS
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12091 N STATE ROAD 37
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-8986
Practice Address - Country:US
Practice Address - Phone:765-298-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11021589A207Q00000X
IN01088272A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine