Basic Information
| Provider Information | |||||||||
| NPI: | 1811085889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPEAR | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3545 W 95TH ST | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608052135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083465562 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3545 W 95TH ST | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083465562 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036-110866 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 01065128A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 036110866 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 36110866 | 05 | IL | MEDICAID | 01065128A | 01 | IN | LICENSE NUMBER | OTHER | 256640002 | 05 | IN | MEDICAID | 036-110866 | 01 | IL | LICENSE NUMBER | OTHER | R02188 | 01 | IL | MEDICARE PTAN# | OTHER | P00713306/CK6882 | 01 | IL | MEDICARE RAIL ROAD | OTHER | 201027840 | 01 | IN | MEDICARE IN | OTHER |