Provider Demographics
NPI:1104859107
Name:MINORE, WILLIAM STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:MINORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-654-5342
Practice Address - Street 1:1235 N MULFORD RD STE 222
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-397-8400
Practice Address - Fax:815-229-0050
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075603207L00000X
IL036.075603207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075603Medicaid
027274OtherHEALTH ALLIANCE
027274OtherHEALTH ALLIANCE
IL036075603Medicaid
IL610900/L03943Medicare PIN
050022543Medicare PIN
C39668Medicare UPIN