=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679526941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM A. EARMAN JR. D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 11/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6450 W COLLEGE DRIVE
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-389-1500
-----------------------------------------------------
Fax | 708-389-3322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12251 S 80TH AVE STE 1630
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-5173
-----------------------------------------------------
Fax | 708-923-5108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | 036073708
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------