MEDICARE: DR. NIGEL N WALTERS MD

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
1	207R00000X	Internal Medicine Physician	036090982	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326073750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIGEL N WALTERS MD

Provider Business Mailing Address
First Line	:	199 W RAND RD STE 203
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-1157
Country	:	US
Telephone Number	:	847-618-5450
Fax Number	:	847-618-5459

Provider Business Practice Location Address
First Line	:	199 W. RAND ROAD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1129
Country	:	US
Telephone Number	:	847-618-5450
Fax Number	:	847-618-5459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/11/2021

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