Provider Demographics
NPI:1447276126
Name:WALKER, MATTHEW T (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2475
Mailing Address - Fax:847-570-2942
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60611-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2475
Practice Address - Fax:847-570-2942
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361039692085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN248120Medicare PIN
H26723Medicare UPIN