Provider Demographics
NPI:1184805277
Name:ELSIE R. WALKER M. D., P. C.
Entity type:Organization
Organization Name:ELSIE R. WALKER M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:WALKER THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-721-0470
Mailing Address - Street 1:8015 S LUELLA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1199
Mailing Address - Country:US
Mailing Address - Phone:773-721-0470
Mailing Address - Fax:773-721-0470
Practice Address - Street 1:8015 S LUELLA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1199
Practice Address - Country:US
Practice Address - Phone:773-721-0470
Practice Address - Fax:773-721-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3160223878OtherBLUE CROSS AND BLUE SHIEL
IL242068OtherHARMONY
IL036068920Medicaid
IL110022723OtherRAIL ROAD MEDICARE
IL242068OtherHARMONY
IL036068920Medicaid