Provider Demographics
NPI:1235252495
Name:CARLOCK, WILLIAM DELOS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DELOS
Last Name:CARLOCK
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 1:1140 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1772
Mailing Address - Country:US
Mailing Address - Phone:847-256-4932
Mailing Address - Fax:
Practice Address - Street 1:1140 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1772
Practice Address - Country:US
Practice Address - Phone:847-256-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360391042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41138Medicare UPIN
IL453650Medicare ID - Type Unspecified