Provider Demographics
NPI:1699850610
Name:IMLACH, WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:IMLACH
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5923
Mailing Address - Fax:
Practice Address - Street 1:4001 VOLLMER RD.
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-481-8883
Practice Address - Fax:708-481-2917
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091396Medicaid
IL373150Medicare ID - Type Unspecified