Provider Demographics
NPI:1215936406
Name:WROBEL, WALTER C (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:C
Last Name:WROBEL
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 1:623 E MAUDE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4045
Mailing Address - Country:US
Mailing Address - Phone:847-749-2274
Mailing Address - Fax:
Practice Address - Street 1:623 E. MAUDE AVE.
Practice Address - Street 2:WALTER WROBEL
Practice Address - City:ARLINGTON HTS.
Practice Address - State:IL
Practice Address - Zip Code:60004-4045
Practice Address - Country:US
Practice Address - Phone:847-749-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036039387208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-039387Medicaid
IL036-039387Medicaid