Healthcare Provider Details

I. General information

NPI: 1700098548
Provider Name (Legal Business Name): WALTON RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E WALTON ST SUITE 106
CHICAGO IL
60611-1448
US

IV. Provider business mailing address

PO BOX 1759
HIGHLAND PARK IL
60035-7759
US

V. Phone/Fax

Practice location:
  • Phone: 312-202-0777
  • Fax: 312-587-1110
Mailing address:
  • Phone: 847-433-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ANDREW S ROSENSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-202-0777