Healthcare Provider Details

I. General information

NPI: 1194219212
Provider Name (Legal Business Name): BIANCA MONIQUE WILLIAMS MD/MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 S COTTAGE GROVE AVE
CHICAGO IL
60637-2530
US

IV. Provider business mailing address

1449 E 65TH PL UNIT 3
CHICAGO IL
60637-4402
US

V. Phone/Fax

Practice location:
  • Phone: 312-682-6110
  • Fax:
Mailing address:
  • Phone: 773-402-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036156363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: