Provider Demographics
NPI:1417956947
Name:BULL, WILLIAM JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:BULL
Suffix:JR
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 1:1307 MACOM DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-3202
Mailing Address - Country:US
Mailing Address - Phone:630-717-6000
Mailing Address - Fax:630-717-6777
Practice Address - Street 1:1307 MACOM DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-3202
Practice Address - Country:US
Practice Address - Phone:630-717-6000
Practice Address - Fax:630-717-6777
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-09-28
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
IL036102621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102621Medicaid
205838Medicare ID - Type Unspecified
IL036102621Medicaid