Provider Demographics
NPI:1689615387
Name:MYALLS, WALTER A (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:MYALLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1741 MISSION HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5707
Mailing Address - Country:US
Mailing Address - Phone:847-698-3600
Mailing Address - Fax:847-318-2949
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:STE 535
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-698-3600
Practice Address - Fax:847-318-2949
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39333Medicare UPIN