| Miroslaw Walo, Md Sc | |
|
4905 Old Orchard Ctr Ste 428 Skokie IL 60077-1458 | |
| (847) 324-4300 | |
| (847) 324-4303 |
| Full Name | Miroslaw Walo, Md Sc |
|---|---|
| Speciality | Psychologist |
| Location | 4905 Old Orchard Ctr, Skokie, 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 |
|---|---|
| Miroslaw Walo, Md Sc 4905 Old Orchard Ctr Ste 428 Skokie IL 60077 Ph: (847) 324-4300 | Miroslaw Walo, Md Sc 4905 Old Orchard Ctr Ste 428 Skokie IL 60077-1458 Ph: (847) 324-4300 |
| NPI Number | 1679772479 |
|---|---|
| Provider Enumeration Date | 07/12/2007 |
| Last Update Date | 03/29/2017 |
| Medicare PECOS PAC ID | 2668369331 |
|---|---|
| Medicare Enrollment ID | O20040228000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679772479 | NPI | - | NPPES |
| 036093864 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 042618878 (Illinois) | Primary |
| 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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