Healthcare Provider Details

I. General information

NPI: 1447352711
Provider Name (Legal Business Name): LORI ANNE WALSH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI WALSH EDWARDS

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W HIGHWAY 22
BARRINGTON IL
60010-1919
US

IV. Provider business mailing address

450 W HIGHWAY 22
BARRINGTON IL
60010-1919
US

V. Phone/Fax

Practice location:
  • Phone: 847-842-3140
  • Fax: 847-842-3149
Mailing address:
  • Phone: 847-842-3149
  • Fax: 847-842-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-078605
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number036-078605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: