Provider Demographics
NPI:1629080742
Name:WILLIAMS, EVELEIGH E (DPM)
Entity Type:Individual
Prefix:
First Name:EVELEIGH
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 GOVERNORS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-3001
Mailing Address - Country:US
Mailing Address - Phone:708-748-7653
Mailing Address - Fax:708-748-3106
Practice Address - Street 1:20000 GOVERNORS DR STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-748-7653
Practice Address - Fax:708-748-3106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004701332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004701Medicaid
IL01606219OtherBCBS
IL01606219OtherBCBS
U54512Medicare UPIN
4236470001Medicare NSC
361190Medicare PIN