MEDICARE: DR. WILLIAM C DAM MD

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	207R00000X	Internal Medicine Physician	036047653	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B4900842	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1447236229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C DAM MD

Provider Business Mailing Address
First Line	:	214 WASHINGTON ST
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041
Country	:	US
Telephone Number	:	847-587-3004
Fax Number	:	847-587-4325

Provider Business Practice Location Address
First Line	:	214 WASHINGTON ST
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041
Country	:	US
Telephone Number	:	847-587-3004
Fax Number	:	847-587-4325

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	01/30/2013

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