| Doctor Name: | MICHAEL WALLER |
| NPI Number: | 1558542241 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 954494 |
| Business Practice Address: | 600 Hart Rd Suite 115 Barrington, IL - 600102623 |
| Business Phone Number: | 8472777444 |
| Business Fax Number: | |
| Mailing Address: | 12400 S Harlem Ave, PALOS HEIGHTS |
| State: | IL |
| Postal Code: | 604631440 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/21/2007 |
| NPI Last Update Date: | 11/21/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225500000X |
| License Number: | 954494 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |