Healthcare Provider Details

I. General information

NPI: 1962325696
Provider Name (Legal Business Name): WILLIAM DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N HARLEM AVE # 2600
CHICAGO IL
60707-4303
US

IV. Provider business mailing address

1742 N HUMBOLDT BLVD APT 301
CHICAGO IL
60647-5161
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.016335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: