Basic Information
| Provider Information | |||||||||
| NPI: | 1477724102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK W. WILLIAMS, M.D., PH.D., GENERAL SURGERY, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 PARK AVE E | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PRINCETON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613563901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158729491 | ||||||||
| FaxNumber: | 8158754060 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 PARK AVE E | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | PRINCETON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613563901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158729491 | ||||||||
| FaxNumber: | 8158754060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2008 | ||||||||
| LastUpdateDate: | 03/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8158729491 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.