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NPI Code Detail

MEDICARE: MARTIN WALSH

MEDICARE: MARTIN WALSH
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
1146N00000XBasic Emergency Medical Technician11 815001IL

General Provider Information

NPI Number : 1598123481
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN WALSH
Provider Business Mailing Address
First Line : 1129 S HERMITAGE AVE
Second Line : ROOM 101
City : CHICAGO
State : IL
Zip : 60612-2607
Country : US
Telephone Number : 312-355-4367
Fax Number :
Provider Business Practice Location Address
First Line : 395 W LAKE ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-1508
Country : US
Telephone Number : 630-530-2988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2016
Last Update Date : 02/05/2016

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Directions to “ MARTIN WALSH ” Practice Location

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