MEDICARE: DR. REGINA P WALKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	036-076781	IL

General Provider Information

NPI Number	:	1538143557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA P WALKER MD

Provider Business Mailing Address
First Line	:	4475 LAWN AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1283
Country	:	US
Telephone Number	:	708-246-4475
Fax Number	:	708-246-1109

Provider Business Practice Location Address
First Line	:	4475 LAWN AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1283
Country	:	US
Telephone Number	:	708-246-4475
Fax Number	:	708-246-1109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	09/16/2015

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