Provider Demographics
NPI:1801879465
Name:WILLIAMS, RHONDA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:#203
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-797-4255
Mailing Address - Fax:630-797-4259
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:#203
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-797-4255
Practice Address - Fax:630-797-4259
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE PTAN (GROUP)
IL0222075OtherCDPG BCBS
IL1033149844OtherCDPG NPI
IL036074825Medicaid
IL920540005OtherMEDICARE PTAN (INDIVIDUAL)
IL920540005OtherMEDICARE PTAN (INDIVIDUAL)