Provider Demographics
NPI:1417766742
Name:WILLIAMS PERSONALIZED CARE LLC
Entity type:Organization
Organization Name:WILLIAMS PERSONALIZED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-807-2320
Mailing Address - Street 1:3200 SOUTH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3185
Mailing Address - Country:US
Mailing Address - Phone:765-366-5776
Mailing Address - Fax:765-807-2330
Practice Address - Street 1:2525 SOUTH ST STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3028
Practice Address - Country:US
Practice Address - Phone:765-807-2320
Practice Address - Fax:765-807-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty