Individual
WILLIAM G DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 269-0000
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 269-0000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036131401
IL
207P00000X
Emergency Medicine Physician
222685
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2091291
—
MA
01
—
469667
TUFTS
MA
01
—
J28564
BCBS
MA
Enumeration date
02/28/2006
Last updated
04/06/2021
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