Provider Demographics
NPI:1912185901
Name:WALSH, WILLIAM ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:WALSH
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 1:9919 S BELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1819
Mailing Address - Country:US
Mailing Address - Phone:773-239-5270
Mailing Address - Fax:
Practice Address - Street 1:9919 S BELL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1819
Practice Address - Country:US
Practice Address - Phone:773-239-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL720411Medicare PIN
ILD15343Medicare UPIN