Provider Demographics
NPI:1013143494
Name:WILLIAMS, MICHAEL STEFAN (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEFAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 N SOUTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1230
Mailing Address - Country:US
Mailing Address - Phone:217-721-4641
Mailing Address - Fax:
Practice Address - Street 1:2752 N SOUTHPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1230
Practice Address - Country:US
Practice Address - Phone:773-327-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005509213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery