Provider Demographics
NPI:1720040389
Name:BETZ, WILLIAM BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BERNARD
Last Name:BETZ
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 1:2650 N LAKEVIEW AVE
Mailing Address - Street 2:3909
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1840
Mailing Address - Country:US
Mailing Address - Phone:773-348-2024
Mailing Address - Fax:773-348-2024
Practice Address - Street 1:2650 N LAKEVIEW AVE
Practice Address - Street 2:3909
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1840
Practice Address - Country:US
Practice Address - Phone:773-348-2024
Practice Address - Fax:773-348-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI15954Medicare UPIN