Provider Demographics
NPI:1730149261
Name:OLIVER, WILLIAM K III (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:OLIVER
Suffix:III
Gender:M
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:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:1345 UNITY PLACE
Practice Address - Street 2:SUITE 225
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5762
Practice Address - Country:US
Practice Address - Phone:765-449-2436
Practice Address - Fax:765-449-1817
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000620A213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100319200Medicaid
INT65187Medicare UPIN
IN1272900003Medicare NSC
IN480029744Medicare PIN
IN100319200Medicaid