Provider Demographics
NPI:1164425153
Name:CURRY, WALTER LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:CURRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1524
Mailing Address - Country:US
Mailing Address - Phone:815-432-4323
Mailing Address - Fax:815-432-4531
Practice Address - Street 1:101 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1524
Practice Address - Country:US
Practice Address - Phone:815-432-4323
Practice Address - Fax:815-432-4531
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16-2742213E00000X
IN07000609A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60200838OtherBLUE CROSS BLUE SHIELD
IL480128074AMedicare PIN
ILT35811Medicare UPIN
IL268670Medicare PIN
IL60200838OtherBLUE CROSS BLUE SHIELD
IN480033956Medicare PIN
IN391200Medicare PIN