Provider Demographics
NPI:1164648614
Name:WALSH, JEAN L (DO)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:L
Last Name:WALSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:L
Other - Last Name:HUNTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:741 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:IL
Practice Address - Zip Code:60520-9500
Practice Address - Country:US
Practice Address - Phone:815-286-9256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089648207Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02226675OtherBLUE CROSS BLUE SHIELD
IL036089648Medicaid
IL04515143OtherBLUE CROSS BLUE SHIELD
IL0727500005Medicare NSC
IL390361Medicare PIN
IL02226675OtherBLUE CROSS BLUE SHIELD
IL04515143OtherBLUE CROSS BLUE SHIELD
IL390362Medicare PIN