Davenport, William G

Davenport, William G is an individual health care provider with primary practice located at 2160 S 1St Ave , Maywood IL 60153-3328. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Davenport, William G can be contacted via phone (708) 269-0000.

Contact Information

Primary practice address
2160 S 1St Ave Maywood IL 60153-3328
Phone: (708) 269-0000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 222685 Massachusetts
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036131401 Illinois

Profile Details

NPI number 1790751691
LBN Legal business name Davenport, William G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Apr 6th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790751691 NPPES
Massachusetts MEDICAID 2091291
Massachusetts Other J28564
Massachusetts Other 469667

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