Active NPI
William Thomas Fader
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1083795538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-072330
- Practice address
- 3860 W Ogden Ave
Chicago, IL 60623-2460 - Phone
- (773) 843-3601
- Fax
- (773) 843-2704
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-072330 | IL | Primary |
Addresses
Primary practice location
3860 W Ogden Ave
Chicago, IL 60623-2460
Mailing address
3860 W Ogden Ave
Chicago, IL 60623-2460
Phone (773) 843-3601
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-072330 | Other | IL | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-072330 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083795538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3860 W OGDEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606232460",
"telephone_number": "773-843-3601",
"fax_number": "773-843-2704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3860 W OGDEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606232460",
"telephone_number": "773-843-3601",
"fax_number": "773-843-2704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADER",
"first_name": "WILLIAM",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-072330",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "036-072330",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.