Provider Demographics
NPI:1285036079
Name:DR. MICHAEL WILLIAMS PODIATRY INC
Entity Type:Organization
Organization Name:DR. MICHAEL WILLIAMS PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-638-9807
Mailing Address - Street 1:810 FOXWORTH BLVD
Mailing Address - Street 2:UNIT 111
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7032
Mailing Address - Country:US
Mailing Address - Phone:708-638-9507
Mailing Address - Fax:708-698-9191
Practice Address - Street 1:2400 S FINLEY RD
Practice Address - Street 2:UNIT 306
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7029
Practice Address - Country:US
Practice Address - Phone:708-638-9507
Practice Address - Fax:708-698-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16005302261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005302Medicaid
IL016005302Medicaid