Healthcare Provider Details

I. General information

NPI: 1013827898
Provider Name (Legal Business Name): SAMANTHA MARIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S DAMEN AVE # MC802
CHICAGO IL
60612-3727
US

IV. Provider business mailing address

7251 S SOUTH SHORE DR APT 6G
CHICAGO IL
60649-2794
US

V. Phone/Fax

Practice location:
  • Phone: 312-597-9308
  • Fax: 312-996-7800
Mailing address:
  • Phone: 312-597-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: