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NPI Code Detail

MEDICARE: DR. KIMBERLY MARIA WALTON-VERNER MD

MEDICARE: DR. KIMBERLY MARIA WALTON-VERNER 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
1208000000XPediatrics Physician036097904IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036097904OTHERILSTATE MEDICAL LICENSE NUM

General Provider Information

NPI Number : 1912921081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY MARIA WALTON-VERNER MD
Provider Business Mailing Address
First Line : 1645 COTTAGE GROVE AVE
Second Line :
City : FORD HEIGHTS
State : IL
Zip : 60411-3818
Country : US
Telephone Number : 708-753-5800
Fax Number : 708-753-5910
Provider Business Practice Location Address
First Line : 1645 COTTAGE GROVE AVE
Second Line :
City : FORD HEIGHTS
State : IL
Zip : 60411-3818
Country : US
Telephone Number : 708-753-5800
Fax Number : 708-753-5910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 05/04/2021

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