Provider Demographics
NPI:1538231212
Name:REED, WILLIAM RUTHERFORD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUTHERFORD
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E OHIO ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4605
Mailing Address - Country:US
Mailing Address - Phone:312-587-8582
Mailing Address - Fax:
Practice Address - Street 1:400 E OHIO ST APT 1003
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4605
Practice Address - Country:US
Practice Address - Phone:312-587-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43566020207R00000X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL13768OtherPIN
ILAR8910598OtherDEA NUMBER
ILAR8910598OtherDEA NUMBER