Provider Demographics
NPI:1598832552
Name:WALTERS, DANIEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:J
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
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
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
Practice Address - Country:US
Practice Address - Phone:773-586-0050
Practice Address - Fax:773-586-0533
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003479213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL695820Medicare PIN
T11299Medicare UPIN
6265870001Medicare NSC