Provider Demographics
NPI:1679915839
Name:GAMOFF WALKER PEDIATRICS INC.
Entity type:Organization
Organization Name:GAMOFF WALKER PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-722-5616
Mailing Address - Street 1:529 S CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1801
Mailing Address - Country:US
Mailing Address - Phone:847-722-5616
Mailing Address - Fax:
Practice Address - Street 1:1820 W WEBSTER AVE
Practice Address - Street 2:202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2934
Practice Address - Country:US
Practice Address - Phone:847-722-5616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-008439225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty