=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518366855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGINA PALOYAN WALKER, MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2014
-----------------------------------------------------
Last Update Date | 12/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4475 LAWN AVE
-----------------------------------------------------
City | WESTERN SPRINGS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60558-1283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-302-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4475 LAWN AVE
-----------------------------------------------------
City | WESTERN SPRINGS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60558-1283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-302-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. REGINA PALOYAN WALKER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 630-302-1001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 036-076781
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------