Provider Demographics
NPI:1003143652
Name:WILLIAM FORSYTHE, DO, PLLC
Entity Type:Organization
Organization Name:WILLIAM FORSYTHE, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORSYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-366-2108
Mailing Address - Street 1:2502 GALEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7045
Mailing Address - Country:US
Mailing Address - Phone:509-366-2108
Mailing Address - Fax:217-355-8347
Practice Address - Street 1:2502 GALEN DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7045
Practice Address - Country:US
Practice Address - Phone:509-366-2108
Practice Address - Fax:217-355-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty