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NPI Code Detail

MEDICARE: BLAKE WILLIAMS M.D.

MEDICARE: BLAKE 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
1207W00000XOphthalmology Physician125068829IL
2207W00000XOphthalmology Physician01083781AIN

General Provider Information

NPI Number : 1497101018
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE WILLIAMS M.D.
Provider Business Mailing Address
First Line : 180 HARVESTER DR STE 110
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-6686
Country : US
Telephone Number : 773-702-1150
Fax Number :
Provider Business Practice Location Address
First Line : 6850 HOHMAN AVE
Second Line :
City : HAMMOND
State : IN
Zip : 46324-1410
Country : US
Telephone Number : 219-931-7509
Fax Number : 219-937-5093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2016
Last Update Date : 03/06/2025

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