Healthcare Provider Details

I. General information

NPI: 1275550865
Provider Name (Legal Business Name): SUNITA BALRAJ WILLIAMSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W HALF DAY RD
BUFFALO GROVE IL
60089-6591
US

IV. Provider business mailing address

20710 ABBOT CT
FRANKFORT IL
60423-3107
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-0000
  • Fax:
Mailing address:
  • Phone: 815-464-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036092491
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-092491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: