Healthcare Provider Details

I. General information

NPI: 1174043277
Provider Name (Legal Business Name): WILLIAM DANIEL YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST STE AIP
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST STE AIP
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 219-677-7866
  • Fax:
Mailing address:
  • Phone: 219-677-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41120
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number336.1196254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: