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1737 Winnetka Ave Northfield IL 60093-3318 | |
| (847) 324-4300 | |
| (847) 324-4303 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1737 Winnetka Ave, Northfield, Illinois |
| Authorized Official Name and Position | Miroslaw Jan Walo (PRESIDENT) |
| Authorized Official Contact | 8473244300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4905 Old Orchard Ctr Ste 428 Skokie IL 60077 Ph: (847) 324-4300 | 1737 Winnetka Ave Northfield IL 60093-3318 Ph: (847) 324-4300 |
| NPI Number | 1679772479 |
|---|---|
| Provider Enumeration Date | 07/12/2007 |
| Last Update Date | 01/24/2025 |
| Certification Date | 01/24/2025 |
| Medicare PECOS PAC ID | 2668369331 |
|---|---|
| Medicare Enrollment ID | O20040228000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679772479 | NPI | - | NPPES |
| 036093864 | Medicaid | IL |
| Provider Name | Miroslaw J Walo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700954294 PECOS PAC ID: 9537056296 Enrollment ID: I20040228000185 |
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