Provider Demographics
NPI:1447470620
Name:WALT, DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:WALT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 1ST ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-433-8065
Mailing Address - Fax:847-433-8065
Practice Address - Street 1:1770 1ST ST
Practice Address - Street 2:SUITE 330
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-433-8065
Practice Address - Fax:847-433-8447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360841122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry