Individual
MICHAEL C WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
635 EXECUTIVE DR, WILLOWBROOK, IL 60527-5603
(630) 455-6630
(630) 455-6631
Mailing address
104 EISENHOWER DR, CR2, BLOOMINGTON, IL 61701-2060
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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