Healthcare Provider Details

I. General information

NPI: 1508893595
Provider Name (Legal Business Name): TIMOTHY J WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W WALNUT ST
METAMORA IL
61548-8637
US

IV. Provider business mailing address

901 W WALNUT ST
METAMORA IL
61548-8637
US

V. Phone/Fax

Practice location:
  • Phone: 309-367-4144
  • Fax: 309-383-4063
Mailing address:
  • Phone: 309-367-4144
  • Fax: 309-383-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001585
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-133608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: