Provider Demographics
NPI:1326051640
Name:NELSON, WILLIAM LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:NELSON
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 1:87 NORTH AIRLITE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-697-5144
Mailing Address - Fax:847-697-8024
Practice Address - Street 1:87 NORTH AIRLITE
Practice Address - Street 2:SUITE 150
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-697-5144
Practice Address - Fax:847-697-8024
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36091028Medicaid
IL36091028Medicaid
L68528Medicare ID - Type Unspecified