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General NPI Number Information
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NPI Number | 1538366158
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Entity Type | Individual
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Provider Name | BRIAN EDMUND WALCZAK DO
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 2111 OGDEN AVE
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City | AURORA
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State | IL
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Zip | 60504-7597
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Country | US
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Telephone | 630-978-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 OGDEN AVE
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City | AURORA
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State | IL
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Zip | 60504-7597
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101017411
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 106196
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 036163012
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 518269
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036163012
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License Number State | IL
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