Provider Demographics
NPI:1164510772
Name:WALKER, ELSIE R (MD)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:R
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:R
Other - Last Name:WALKER THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8015 S LUELLA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1199
Mailing Address - Country:US
Mailing Address - Phone:773-721-0470
Mailing Address - Fax:773-721-0489
Practice Address - Street 1:8015 S LUELLA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1199
Practice Address - Country:US
Practice Address - Phone:773-721-0470
Practice Address - Fax:773-721-0489
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3160223878OtherBLUE CROSS BLUE SHIELD
IL036068920Medicaid
IL110022723OtherRAIL ROAD MEDICARE
IL242068OtherHARMONY
IL766680Medicare PIN
D16354Medicare UPIN