Provider Demographics
NPI:1093749517
Name:BUSHNELL, WILLIAM FOREST III (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FOREST
Last Name:BUSHNELL
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2815
Mailing Address - Country:US
Mailing Address - Phone:630-530-3338
Mailing Address - Fax:
Practice Address - Street 1:183 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2815
Practice Address - Country:US
Practice Address - Phone:630-530-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38596Medicare UPIN
4237070001Medicare NSC
IL757350Medicare ID - Type Unspecified