Healthcare Provider Details

I. General information

NPI: 1770597759
Provider Name (Legal Business Name): WILLIAM B. HANAFORD, M.D., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 601
PARK RIDGE IL
60068-1168
US

IV. Provider business mailing address

2320 DEAN ST STE 103
ST CHARLES IL
60175-1068
US

V. Phone/Fax

Practice location:
  • Phone: 847-297-0707
  • Fax: 847-297-0770
Mailing address:
  • Phone: 630-377-0106
  • Fax: 630-377-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: WILLIAM HANAFORD
Title or Position: OWNER
Credential: MD
Phone: 847-297-0707