Individual
MARY KATHLEEN WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1611 W HARRISON ST, CHICAGO, IL 60612-4861
(877) 632-6637
Mailing address
2604 WILLIAM DR, VALPARAISO, IN 46385-8182
(219) 246-7981
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
085007391
IL
Other
Enumeration date
01/05/2020
Last updated
01/05/2020
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