MEDICARE: TAKAYLA WILLIAMS DO TAKAYLA WILLIAMS

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	9188784328	AR

General Provider Information

NPI Number	:	1962158055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKAYLA WILLIAMS DO TAKAYLA WILLIAMS

Provider Business Mailing Address
First Line	:	12813 S MAY ST
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11416 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4932
Country	:	US
Telephone Number	:	773-821-1414
Fax Number	:

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

Provider Enumeration Date	:	02/27/2022
Last Update Date	:	02/27/2022

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