Provider Demographics
NPI:1336231638
Name:WILLIAMS, MARIE L (DPM)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NE 213TH ST STE 811
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1264
Mailing Address - Country:US
Mailing Address - Phone:305-932-9232
Mailing Address - Fax:305-932-9536
Practice Address - Street 1:2801 NE 213TH ST STE 811
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1264
Practice Address - Country:US
Practice Address - Phone:305-932-9232
Practice Address - Fax:305-932-9536
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1450213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340509500Medicaid
FLT55542Medicare UPIN