Provider Demographics
NPI:1215940853
Name:WILLIAMS, CHRISTOPHER BRIAN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22737 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-2330
Mailing Address - Country:US
Mailing Address - Phone:708-748-2459
Mailing Address - Fax:708-229-0028
Practice Address - Street 1:22737 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2330
Practice Address - Country:US
Practice Address - Phone:708-748-2459
Practice Address - Fax:708-229-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor