Provider Demographics
NPI:1629131149
Name:HARPER, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:HARPER
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 1:5119 S DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4117
Mailing Address - Country:US
Mailing Address - Phone:855-947-7371
Mailing Address - Fax:312-284-4124
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2020
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:855-947-7371
Practice Address - Fax:312-284-4124
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036097080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097080Medicaid