Provider Demographics
NPI:1902867328
Name:PAYNE, WILLIAM K III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:PAYNE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4253
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:20201 CRAWFORD AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1010
Practice Address - Country:US
Practice Address - Phone:708-679-2310
Practice Address - Fax:708-503-4445
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036093997207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95565OtherMEDICARE PTAN
IL036093997Medicaid
IL036093997Medicaid
G38994Medicare UPIN