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NPI Code Detail

MEDICARE: DR. KENNETH D WILLIAMS MD

MEDICARE: DR. KENNETH D WILLIAMS 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
12085R0202XDiagnostic Radiology Physician036101220IL

General Provider Information

NPI Number : 1790783249
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH D WILLIAMS MD
Provider Business Mailing Address
First Line : PO BOX 2153
Second Line :
City : BEDFORD PARK
State : IL
Zip : 60499-2153
Country : US
Telephone Number : 800-354-1088
Fax Number : 314-631-4491
Provider Business Practice Location Address
First Line : 2701 W 68TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-1813
Country : US
Telephone Number : 773-884-9000
Fax Number : 314-631-4491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 09/04/2008

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Directions to “ DR. KENNETH D WILLIAMS MD” Practice Location

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