Basic Information
| Provider Information | |||||||||
| NPI: | 1134328644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9223 W SAINT FRANCIS RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604238330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158063111 | ||||||||
| FaxNumber: | 8154642621 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 VINE ST | ||||||||
| Address2: | |||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604511666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154634746 | ||||||||
| FaxNumber: | 8154634937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036117200 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 036117200 | 01 | IL | LICENSE | OTHER |