Provider Demographics
NPI:1164724431
Name:DANIEL J. WALTERS DPM PC
Entity Type:Organization
Organization Name:DANIEL J. WALTERS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-586-0050
Mailing Address - Street 1:6545 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2438
Mailing Address - Country:US
Mailing Address - Phone:773-586-0050
Mailing Address - Fax:773-586-0533
Practice Address - Street 1:6545 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2438
Practice Address - Country:US
Practice Address - Phone:773-586-0050
Practice Address - Fax:773-586-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003479213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6265870001Medicare NSC
IL695820Medicare PIN
ILT11299Medicare UPIN