Provider Demographics
NPI:1982659413
Name:DAVISON, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DAVISON
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:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-8283
Mailing Address - Fax:773-767-8320
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:STE 200
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-825-2366
Practice Address - Fax:847-825-2513
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360457402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL130004858OtherRAILROAD MEDICARE
IL036045740Medicaid
IL01615936OtherBLUE SHIELD
IL603770Medicare ID - Type Unspecified
IL01615936OtherBLUE SHIELD