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1265464382

NPI Code Detail

MEDICARE: DR. NIKITA LAVON WILLIAMSON MD

MEDICARE: DR. NIKITA LAVON WILLIAMSON MD

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	208000000X	Pediatrics Physician	86766	WI
2	208000000X	Pediatrics Physician	ME138611	FL
3	208000000X	Pediatrics Physician	036107711	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265464382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKITA LAVON WILLIAMSON MD

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 W 95TH ST STE 2177H
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2600
Country	:	US
Telephone Number	:	708-684-5341
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/26/2026

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Directions to “ DR. NIKITA LAVON WILLIAMSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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