Healthcare Provider Details

I. General information

NPI: 1417913161
Provider Name (Legal Business Name): JAMES WALSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON
NAPERVILLE IL
60540
US

IV. Provider business mailing address

2650 WARRENVILLE RD
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 630-416-8500
  • Fax: 630-416-8694
Mailing address:
  • Phone: 630-324-7911
  • Fax: 630-324-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036067091
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: