Provider Demographics
NPI:1104137140
Name:WILLIAMS, SHERRY MICHELE (MD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:MICHELE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3303 LOGAN DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3732
Practice Address - Country:US
Practice Address - Phone:618-998-8920
Practice Address - Fax:618-998-8923
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124731207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124731Medicaid
IL640701OtherMEDICARE WPS FFS
IL370966854002Medicaid
ILCF3444OtherMEDICARE RR
IL640701OtherMEDICARE WPS FFS