Individual
DR. MIROSLAW JAN WALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 CENTRAL AVE UNIT 4A, WILMETTE, IL 60091-2681
(847) 324-4300
(847) 324-4303
Mailing address
PO BOX 7053, EVANSTON, IL 60204-7053
(847) 668-4415
(847) 324-4303
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036093864
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036-093864
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093864
—
IL
Enumeration date
12/01/2006
Last updated
06/27/2024
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