Healthcare Provider Details

I. General information

NPI: 1659663581
Provider Name (Legal Business Name): GRETCHEN KATHLEEN WILLIAMS D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WALL ST STE B410
KANKAKEE IL
60901-2940
US

IV. Provider business mailing address

400 N WALL ST STE B410
KANKAKEE IL
60901-2940
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-2221
  • Fax: 815-933-3975
Mailing address:
  • Phone: 815-933-2221
  • Fax: 815-933-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101019120
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: