Provider Demographics
NPI:1417122813
Name:WALKER, JEROME ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ROBERT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12432 PHEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7465
Mailing Address - Country:US
Mailing Address - Phone:847-515-3361
Mailing Address - Fax:847-253-4410
Practice Address - Street 1:12432 PHEASANT RIDGE DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7465
Practice Address - Country:US
Practice Address - Phone:847-515-3361
Practice Address - Fax:847-253-4410
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036039375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38187Medicare UPIN