Healthcare Provider Details

I. General information

NPI: 1609936442
Provider Name (Legal Business Name): ANGELA WALKER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

PO BOX 747
KEWANEE IL
61443-8354
US

V. Phone/Fax

Practice location:
  • Phone: 516-286-2240
  • Fax: 309-852-7764
Mailing address:
  • Phone: 309-852-7700
  • Fax: 309-852-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036117158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: