Healthcare Provider Details

I. General information

NPI: 1356323398
Provider Name (Legal Business Name): SEAN DAVID MCWILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DANADA SQ W
WHEATON IL
60189-2041
US

IV. Provider business mailing address

180 DANADA SQ W
WHEATON IL
60189-2041
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-2600
  • Fax: 630-474-2601
Mailing address:
  • Phone: 630-474-2600
  • Fax: 630-474-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036096961
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036096961
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number01062181A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number036096961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: