Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 036075199 | IL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036075799 | IL |
NPI | 1255426169 |
---|---|
Provider Name | Dr. Steven D. Williams |
First Address | Kankakee, IL 60901-0781 |
Second Address | Bourbonnais, IL 60914-4996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036075799 | (05) | IL |
36075799 | (05) | IL |
4632039 | BC GROUP # (01) | IL |
E37086 | (02) | IL |