MEDICARE: WILLIAM C. DAM, M.D.S.C.

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	261QM1300X	Multi-Specialty Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center
3	207N00000X	Dermatology Physician	3647653	IL
4	207R00000X	Internal Medicine Physician	3647653	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4900842	OTHER	IL	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760632459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C. DAM, M.D.S.C.

Provider Business Mailing Address
First Line	:	214 WASHINGTON ST
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041-9208
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	:	60041-9208
Country	:	US
Telephone Number	:	847-587-3004
Fax Number	:	847-587-4325

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. WILLIAM C. DAM
Credential	:	M.D.
Telephone Number	:	847-587-3004

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/21/2021

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