Healthcare Provider Details

I. General information

NPI: 1760286017
Provider Name (Legal Business Name): MR. DAVID WILLIAMS II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 W FOSTER AVE
CHICAGO IL
60625-4823
US

IV. Provider business mailing address

3225 W FOSTER AVE
CHICAGO IL
60625-4823
US

V. Phone/Fax

Practice location:
  • Phone: 773-244-5783
  • Fax:
Mailing address:
  • Phone: 309-368-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number041369780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: