Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 036-090471 | IL |
NPI | 1730171018 |
---|---|
Provider Name | Dr. David L. Walner |
First Address | Niles, IL 60714-5602 |
Second Address | Niles, IL 60714-5602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-090471 | (05) | IL |
G51653 | (02) | IL |