Provider Demographics
NPI:1477641645
Name:EPPERLY, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:EPPERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:245 S GARY AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2218
Mailing Address - Country:US
Mailing Address - Phone:630-893-9661
Mailing Address - Fax:877-780-5145
Practice Address - Street 1:245 S GARY AVE STE 207
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2218
Practice Address - Country:US
Practice Address - Phone:630-893-9661
Practice Address - Fax:877-780-5145
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C46238Medicare UPIN
950370Medicare ID - Type Unspecified