Provider Demographics
NPI:1952744823
Name:BARKER, WALTER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:BARKER
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 1:2912 N. COMMONWEALTH AVE.
Mailing Address - Street 2:#11C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6235
Mailing Address - Country:US
Mailing Address - Phone:773-525-0551
Mailing Address - Fax:773-525-0561
Practice Address - Street 1:2912 N. COMMONWEALTH AVE.
Practice Address - Street 2:#11C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6235
Practice Address - Country:US
Practice Address - Phone:773-525-0551
Practice Address - Fax:773-525-0561
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-032979208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13663Medicare UPIN