MEDICARE: MR. WILLIAM EDWARD DILL II EDD, ATC, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	096-001756	IL

General Provider Information

NPI Number	:	1144293820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM EDWARD DILL II EDD, ATC, CSCS

Provider Business Mailing Address
First Line	:	1103 LANDING PLACE DR
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-4071
Country	:	US
Telephone Number	:	636-299-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 S ILLINOIS ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-2879
Country	:	US
Telephone Number	:	636-299-0049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	06/01/2023

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