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General NPI Number Information
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NPI Number | 1568454775
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Entity Type | Individual
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Provider Name | WILLIAM A CHADWICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 4600 MEMORIAL DR STE 240
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City | BELLEVILLE
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State | IL
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Zip | 62226-5363
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Country | US
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Telephone | 618-234-2390
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Fax | 618-234-9936
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Provider Business Mailing Address
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Address Line | 4600 MEMORIAL DR SUITE 400
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City | BELLEVILLE
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State | IL
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Zip | 62226-5366
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Country | US
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Telephone | 618-234-2390
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Fax | 618-234-9936
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-082912
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License Number State | IL
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