Provider Demographics
NPI:1013195650
Name:WILLIAMS, JONATHAN F (D0)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:D0
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1002
Mailing Address - Country:US
Mailing Address - Phone:847-256-3400
Mailing Address - Fax:847-256-3412
Practice Address - Street 1:510 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1002
Practice Address - Country:US
Practice Address - Phone:847-256-3400
Practice Address - Fax:847-256-3412
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111829207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK51909Medicare PIN