Healthcare Provider Details

I. General information

NPI: 1124158076
Provider Name (Legal Business Name): ROBERT L WALKER HT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 SAINT CHARLES RD UNIT F
BELLWOOD IL
60104-1054
US

IV. Provider business mailing address

5133 SAINT CHARLES RD UNIT F
BELLWOOD IL
60104-1054
US

V. Phone/Fax

Practice location:
  • Phone: 708-547-1999
  • Fax: 708-547-1699
Mailing address:
  • Phone: 708-547-1999
  • Fax: 708-547-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QH0600X
TaxonomyHistology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: