Individual
MARK ANDREW WALSHAUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
321 REGENCY PARK STE 100, O FALLON, IL 62269-1887
(618) 416-7970
(618) 416-7971
Mailing address
PO BOX 25228, DECATUR, IL 62525-5228
(217) 329-3232
(217) 233-1670
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2010024540
MO
207RH0003X
Hematology & Oncology Physician
Primary
036128331
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036128331
—
IL
Enumeration date
12/21/2007
Last updated
12/12/2023
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