Healthcare Provider Details

I. General information

NPI: 1437254356
Provider Name (Legal Business Name): PETER R WILLIAMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

808 S WOOD ST 885-1 CME, MC 735
CHICAGO IL
60612-7300
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-996-6070
  • Fax: 312-413-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036090555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: