Healthcare Provider Details

I. General information

NPI: 1356325328
Provider Name (Legal Business Name): DAVID WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S DREXEL BLVD
CHICAGO IL
60615-1703
US

IV. Provider business mailing address

4801 S DREXEL BLVD
CHICAGO IL
60615-1703
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.087673
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036087673
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD447590
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: