MEDICARE: DR. JAMES BERTRAM WILLIAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036099138	IL
2	2086S0129X	Vascular Surgery Physician	036099138	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00059260	OTHER	IL	RETIRED RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	IL0101/010794248-01	OTHER	IL	JOHN DEERE
4	7232062	OTHER	IL	BLUE SHIELD PROVIDER NO

General Provider Information

NPI Number	:	1265433882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES BERTRAM WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	2420 W NEBRASKA AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3112
Country	:	US
Telephone Number	:	309-680-5000
Fax Number	:	309-680-1002

Provider Business Practice Location Address
First Line	:	2420 W NEBRASKA AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3112
Country	:	US
Telephone Number	:	309-680-5000
Fax Number	:	309-680-1002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	06/28/2011

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Directions to “ DR. JAMES BERTRAM WILLIAMS M.D.” Practice Location

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