Provider Demographics
NPI:1942458237
Name:PARK, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:EDWARD HINES JR VA HOSPITAL
Mailing Address - Street 2:BUILDING 200, RM A153
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-2175
Practice Address - Street 1:1300 N HIGHLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1481
Practice Address - Country:US
Practice Address - Phone:630-897-5104
Practice Address - Fax:630-897-5089
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2024-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.121758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121758Medicaid
IL362765923Medicaid
IL542440001OtherWPS PROVIDER NUMBER
ILCC2168OtherRR MC GROUP
P00819332OtherRR MEDICARE
ILCC2168OtherRR MC GROUP