Provider Demographics
NPI:1003877606
Name:HARDY, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1430 COLLEGE DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-2649
Mailing Address - Country:US
Mailing Address - Phone:618-263-3869
Mailing Address - Fax:618-262-7351
Practice Address - Street 1:1430 COLLEGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2649
Practice Address - Country:US
Practice Address - Phone:618-263-3869
Practice Address - Fax:618-262-7351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL98248Medicare ID - Type Unspecified
ILE02611Medicare UPIN