Healthcare Provider Details

I. General information

NPI: 1003828336
Provider Name (Legal Business Name): WILLIAM P KEARNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 SUSSEX CORNER LN
PROSPECT HEIGHTS IL
60070-2569
US

IV. Provider business mailing address

756 SUSSEX CORNER LN
PROSPECT HEIGHTS IL
60070-2569
US

V. Phone/Fax

Practice location:
  • Phone: 847-870-8236
  • Fax:
Mailing address:
  • Phone: 847-870-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3640458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: