Provider Demographics
NPI:1477724102
Name:MARK W. WILLIAMS, M.D., PH.D., GENERAL SURGERY, S.C.
Entity Type:Organization
Organization Name:MARK W. WILLIAMS, M.D., PH.D., GENERAL SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:815-872-9491
Mailing Address - Street 1:530 PARK AVE E
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-3901
Mailing Address - Country:US
Mailing Address - Phone:815-872-9491
Mailing Address - Fax:815-875-4060
Practice Address - Street 1:530 PARK AVE E
Practice Address - Street 2:SUITE 205
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-3901
Practice Address - Country:US
Practice Address - Phone:815-872-9491
Practice Address - Fax:815-875-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty