Provider Demographics
NPI:1518038488
Name:ZANDER, WILLIAM M (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:ZANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOOD DUCK LN
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9685
Mailing Address - Country:US
Mailing Address - Phone:815-434-1111
Mailing Address - Fax:815-434-1112
Practice Address - Street 1:1315 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1447
Practice Address - Country:US
Practice Address - Phone:815-539-7461
Practice Address - Fax:815-539-1461
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086818207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086818Medicaid
F72505Medicare UPIN
ILK01057Medicare UPIN
IL211332Medicare PIN