Healthcare Provider Details

I. General information

NPI: 1518229772
Provider Name (Legal Business Name): ANDREW L WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD STE 201
SAINT JOSEPH MO
64507
US

IV. Provider business mailing address

1229 N PAULINA ST UNIT 2
CHICAGO IL
60622-3851
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7280
  • Fax: 816-271-1047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036.142912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: