Provider Demographics
NPI:1699742163
Name:WALIGORA, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WALIGORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2150 PFINGSTEN RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1326
Mailing Address - Country:US
Mailing Address - Phone:847-869-1499
Mailing Address - Fax:847-657-1898
Practice Address - Street 1:2150 PFINGSTEN RD STE 1200
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1326
Practice Address - Country:US
Practice Address - Phone:847-869-8149
Practice Address - Fax:847-657-1898
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036090476207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03609076Medicaid
ILL93655Medicare PIN
IL03609076Medicaid