Provider Demographics
NPI:1124067335
Name:FALKOWSKI, WALTER S (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:S
Last Name:FALKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3159
Mailing Address - Country:US
Mailing Address - Phone:847-470-0297
Mailing Address - Fax:847-470-0302
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-470-0297
Practice Address - Fax:847-470-0302
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054644208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054644Medicaid
ILP00272450OtherRAILROAD MEDICARE
K20922Medicare PIN
ILP00272450OtherRAILROAD MEDICARE