MEDICARE: MR. GEORGE LENWORTH WALKER DDS

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	1223G0001X	General Practice Dentistry	19A15006	IL

General Provider Information

NPI Number	:	1811191190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE LENWORTH WALKER DDS

Provider Business Mailing Address
First Line	:	1515 EAST 52ND PLACE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60615-4390
Country	:	US
Telephone Number	:	773-752-3832
Fax Number	:	773-752-3879

Provider Business Practice Location Address
First Line	:	1515 EAST 52ND PLACE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60615-4390
Country	:	US
Telephone Number	:	773-752-3832
Fax Number	:	773-752-3879

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	03/18/2019

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