Healthcare Provider Details

I. General information

NPI: 1093749517
Provider Name (Legal Business Name): WILLIAM FOREST BUSHNELL III D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 W 1ST ST
ELMHURST IL
60126-2815
US

IV. Provider business mailing address

183 W 1ST ST
ELMHURST IL
60126-2815
US

V. Phone/Fax

Practice location:
  • Phone: 630-530-3338
  • Fax:
Mailing address:
  • Phone: 630-530-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: