Provider Demographics
NPI:1700098548
Name:WALTON RADIOLOGY PC
Entity Type:Organization
Organization Name:WALTON RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-202-0777
Mailing Address - Street 1:PO BOX 1759
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-7759
Mailing Address - Country:US
Mailing Address - Phone:847-433-8300
Mailing Address - Fax:
Practice Address - Street 1:100 E WALTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1448
Practice Address - Country:US
Practice Address - Phone:312-202-0777
Practice Address - Fax:312-587-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty