Provider Demographics
NPI:1780798397
Name:WALLMAN MEDICAL ASSOCIATES, S.C.
Entity type:Organization
Organization Name:WALLMAN MEDICAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:WALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-901-5200
Mailing Address - Street 1:2501 COMPASS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8000
Mailing Address - Country:US
Mailing Address - Phone:847-901-5200
Mailing Address - Fax:847-901-5225
Practice Address - Street 1:2501 COMPASS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8000
Practice Address - Country:US
Practice Address - Phone:847-901-5200
Practice Address - Fax:847-901-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212473OtherSITE NUMBER
ILH73524Medicare UPIN