Healthcare Provider Details

I. General information

NPI: 1336043041
Provider Name (Legal Business Name): KEITH L WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KLW LLC

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 W 159TH ST
MARKHAM IL
60428-4003
US

IV. Provider business mailing address

3065 W 159TH ST
MARKHAM IL
60428-4003
US

V. Phone/Fax

Practice location:
  • Phone: 708-540-2149
  • Fax: 708-498-1170
Mailing address:
  • Phone: 708-540-2149
  • Fax: 708-498-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: