MEDICARE: DR. PENNY SUE WALKER M.D.

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	207P00000X	Emergency Medicine Physician	4301079079	MI
2	207P00000X	Emergency Medicine Physician		IL

General Provider Information

NPI Number	:	1659438497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY SUE WALKER M.D.

Provider Business Mailing Address
First Line	:	440 RIDGEWAY ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-1053
Country	:	US
Telephone Number	:	269-985-0592
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E WACKER DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-3713
Country	:	US
Telephone Number	:	312-997-6722
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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