Provider Demographics
NPI:1124176383
Name:PRICE, WILLIAM HENRY (RSA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:PRICE
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Gender:M
Credentials:RSA
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Mailing Address - Street 1:4819 5TH AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-2924
Mailing Address - Country:US
Mailing Address - Phone:847-917-3666
Mailing Address - Fax:888-370-3138
Practice Address - Street 1:4819 5TH AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-2924
Practice Address - Country:US
Practice Address - Phone:847-917-3666
Practice Address - Fax:888-370-3138
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2014-10-22
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Provider Licenses
StateLicense IDTaxonomies
IL238.000016363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical