Provider Demographics
NPI:1720030646
Name:WILLIAMS, RANDALL EARL (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:EARL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:SUITE B202 ATTN JAN LEWIS
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:630-268-1102
Mailing Address - Fax:
Practice Address - Street 1:27750 W HIGHWAY 22
Practice Address - Street 2:SUITE 240
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2379
Practice Address - Country:US
Practice Address - Phone:847-829-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091021207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091021Medicaid
P00166673OtherRAILROAD MEDICARE
IL036091021Medicaid
ILK03489Medicare ID - Type UnspecifiedLOCAL 16
P00166673OtherRAILROAD MEDICARE
E62606Medicare UPIN