Healthcare Provider Details

I. General information

NPI: 1124645700
Provider Name (Legal Business Name): TIMOTHY ALAN WILLIAMS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E 75TH ST FL 1
CHICAGO IL
60649-3603
US

IV. Provider business mailing address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3954
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7310
  • Fax:
Mailing address:
  • Phone: 773-947-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.077201
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036163881
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: