Provider Demographics
NPI:1396711073
Name:WILLIAMS, GARY L (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13929 APACHE LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1869
Mailing Address - Country:US
Mailing Address - Phone:708-444-4114
Mailing Address - Fax:708-403-9229
Practice Address - Street 1:6307 S STEWART AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:708-444-4114
Practice Address - Fax:708-403-9229
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004979213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004979Medicaid