Healthcare Provider Details

I. General information

NPI: 1285684688
Provider Name (Legal Business Name): WILLIAM D WOODWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 COPPERFIELD AVE SUITE 3030
JOLIET IL
60432-2004
US

IV. Provider business mailing address

1300 COPPERFIELD AVE SUITE 3030
JOLIET IL
60432-2004
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1900
  • Fax: 815-729-3294
Mailing address:
  • Phone: 815-740-1900
  • Fax: 815-729-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036050962
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: