Healthcare Provider Details

I. General information

NPI: 1255426169
Provider Name (Legal Business Name): STEVEN D. WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RIVERSIDE DR. SUITE 2500
BOURBONNAIS IL
60914-4996
US

IV. Provider business mailing address

PO BOX 781
KANKAKEE IL
60901-0781
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-7141
  • Fax: 815-937-1670
Mailing address:
  • Phone: 815-935-7538
  • Fax: 815-935-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036075799
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036075199
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: