Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | IL |
NPI | 1255468054 |
---|---|
Provider Name | Dr. Michael Anthony Walsh |
First Address | Franklin Park, IL 60131-2679 |
Second Address | Franklin Park, IL 60131-2679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |