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NPI Code Detail

MEDICARE: WALTER J BEUSSE DO

MEDICARE:   WALTER J BEUSSE  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036083241IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
205623130OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1083612329
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER J BEUSSE DO
Provider Business Mailing Address
First Line : PO BOX 7425
Second Line :
City : ALGONQUIN
State : IL
Zip : 60102-7425
Country : US
Telephone Number : 630-213-3217
Fax Number : 630-213-8140
Provider Business Practice Location Address
First Line : 824 W BARTLETT RD
Second Line :
City : BARTLETT
State : IL
Zip : 60103-4402
Country : US
Telephone Number : 630-213-3217
Fax Number : 630-213-8140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 05/18/2022

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