Healthcare Provider Details

I. General information

NPI: 1760632459
Provider Name (Legal Business Name): WILLIAM C. DAM, M.D.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WASHINGTON ST
INGLESIDE IL
60041-9208
US

IV. Provider business mailing address

214 WASHINGTON ST
INGLESIDE IL
60041-9208
US

V. Phone/Fax

Practice location:
  • Phone: 847-587-3004
  • Fax: 847-587-4325
Mailing address:
  • Phone: 847-587-3004
  • Fax: 847-587-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3647653
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3647653
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM C. DAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 847-587-3004