Provider Demographics
NPI:1588689756
Name:WILLIAMS, KAREN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
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:PO BOX 2119
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-2119
Mailing Address - Country:US
Mailing Address - Phone:270-737-1212
Mailing Address - Fax:
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:270-706-1650
Practice Address - Fax:270-706-1058
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY191122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000517648OtherANTHEM BCBS
KY50014789OtherPASSPORT
KY64191125Medicaid
KY2843065000OtherPASSPORT ADVANTAGE
KYP00453564OtherRAILROAD MEDICARE
KY3362734OtherCIGNA
KYP00453564OtherRAILROAD MEDICARE
KY1284305Medicare ID - Type Unspecified
KY00011017Medicare PIN