Provider Demographics
NPI:1356323398
Name:MCWILLIAMS, SEAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:DAVID
Last Name:MCWILLIAMS
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 1:180 DANADA SQ W
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2041
Mailing Address - Country:US
Mailing Address - Phone:630-474-2600
Mailing Address - Fax:630-474-2601
Practice Address - Street 1:180 DANADA SQ W
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2041
Practice Address - Country:US
Practice Address - Phone:630-474-2600
Practice Address - Fax:630-474-2601
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096961207Q00000X, 2086S0129X, 202K00000X
IN01062181A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00419402OtherMEDICARE RAILROAD INDIVIDUAL PTAN
IL01622308OtherBLUE CROSS
ILP00426506OtherMEDICARE RAILROAD INDIVIDUAL PTAN
IL01622308OtherBLUE CROSS
G72376Medicare UPIN
INP00419402OtherMEDICARE RAILROAD INDIVIDUAL PTAN
ILK34683Medicare PIN
IN250520AMedicare PIN
IL789511011Medicare PIN
ILK34685Medicare PIN