| Doctor Name: | DR. RICHARD JOSEPH WALLYN |
| NPI Number: | 1033343132 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 036-32156 |
| Business Practice Address: | 1300 Brassie Ave. Flossmoor, IL - 604221812 |
| Business Phone Number: | 7087981356 |
| Business Fax Number: | 7087981356 |
| Mailing Address: | 1300 Brassie Ave., FLOSSMOOR |
| State: | IL |
| Postal Code: | 604221812 |
| Phone Number: | 7087981356 |
| Fax Number: | 7087981356 |
| NPI Enumeration Date: | 05/05/2009 |
| NPI Last Update Date: | 05/05/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0401X |
| License Number: | 036-32156 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |