MEDICARE: WILLIAM ELLIOTT M.D.

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	2083P0901X	Public Health & General Preventive Medicine Physician		IL

General Provider Information

NPI Number	:	1427073998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ELLIOTT M.D.

Provider Business Mailing Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 470
City	:	CHICAGO
State	:	IL
Zip	:	60612-3218
Country	:	US
Telephone Number	:	312-942-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 470
City	:	CHICAGO
State	:	IL
Zip	:	60612-3218
Country	:	US
Telephone Number	:	312-942-3133
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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