Provider Demographics
NPI:1043393705
Name:MORRISSEY, WALTER WADE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WADE
Last Name:MORRISSEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-3726
Mailing Address - Country:US
Mailing Address - Phone:630-215-3085
Mailing Address - Fax:
Practice Address - Street 1:1516 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-3726
Practice Address - Country:US
Practice Address - Phone:630-215-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36110468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine