Healthcare Provider Details

I. General information

NPI: 1598968059
Provider Name (Legal Business Name): BRYAN SCOTT WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1808 S. MICHIGAN AVE #29
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-1903
  • Fax:
Mailing address:
  • Phone: 312-808-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number36112988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: