Individual
MR. NICHOLAS TYLER WALSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(888) 352-7874
Mailing address
1520 S MAIN ST, STE 2, DAYTON, OH 45409-2643
(937) 461-5815
(937) 461-2896
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-007-156
IL
Other
Enumeration date
05/29/2019
Last updated
11/22/2021
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