Provider Demographics
NPI:1780663484
Name:VIRKUS, WALTER W (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:W
Last Name:VIRKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:STE 535
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1204
Practice Address - Country:US
Practice Address - Phone:317-963-1950
Practice Address - Fax:317-963-1955
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071856A207X00000X, 207XX0801X
IL036102954207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102954 2Medicaid
IL207073OtherMEDICARE PTAN LOCALITY 15
ILP00286665OtherRR MEDICARE ID#
IL1633878OtherBCBS GROUP ID#
IN201127550Medicaid
IL207067OtherMEDICARE PTAN LOCALITY 16
ILDA4902OtherRR MEDICARE PTAN #
IL7736149OtherAETNA ID#
IL036102954 2Medicaid
INP01180491Medicare PIN
ILK16954Medicare PIN
IL207073OtherMEDICARE PTAN LOCALITY 15
IL1633878OtherBCBS GROUP ID#