Provider Demographics
NPI:1538143557
Name:WALKER, REGINA P (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:P
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1283
Mailing Address - Country:US
Mailing Address - Phone:708-246-4475
Mailing Address - Fax:708-246-1109
Practice Address - Street 1:4475 LAWN AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1283
Practice Address - Country:US
Practice Address - Phone:708-246-4475
Practice Address - Fax:708-246-1109
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076781207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL949121Medicare PIN
ILF100181267Medicare PIN
E87211Medicare UPIN
ILF400181868Medicare PIN