Provider Demographics
NPI:1215463955
Name:MACIAS, WILLIAM LOUIS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOUIS
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9129 LOG RUN DR S
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1343
Mailing Address - Country:US
Mailing Address - Phone:317-291-7862
Mailing Address - Fax:
Practice Address - Street 1:9129 LOG RUN DR S
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1343
Practice Address - Country:US
Practice Address - Phone:317-291-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037069A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology