MEDICARE: MS. DEJA WALKER

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1831085307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEJA WALKER

Provider Business Mailing Address
First Line	:	1649 N MOODY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3923
Country	:	US
Telephone Number	:	872-283-9283
Fax Number	:	872-283-9283

Provider Business Practice Location Address
First Line	:	1649 N MOODY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3923
Country	:	US
Telephone Number	:	872-283-9283
Fax Number	:	872-283-9283

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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