Basic Information
| Provider Information | |||||||||
| NPI: | 1609936442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 747 | ||||||||
| Address2: | |||||||||
| City: | KEWANEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614438354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098527700 | ||||||||
| FaxNumber: | 3098527764 | ||||||||
| Practice Location | |||||||||
| Address1: | 468 CADIEUX RD | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482301507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162862240 | ||||||||
| FaxNumber: | 3098527764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 12/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036117158 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5101015379 | 01 | MI | LICENSE | OTHER | MD036117158 | 01 | IL | ILLINOIS LICENSE | OTHER | 3715468 | 01 | IL | BCBS | OTHER | 036117158 | 05 | IL | MEDICAID |