Provider Demographics
NPI:1871549238
Name:GREATHOUSE-WILLIAMS, DEIRDRA (MD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRA
Middle Name:
Last Name:GREATHOUSE-WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:815-463-3700
Mailing Address - Fax:815-463-3701
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 570
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-463-3700
Practice Address - Fax:815-463-3701
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061341A207Q00000X
IL036114405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114405Medicaid
IL036114405Medicaid