Walter Tatch

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

021002076 Issued in IL

Practice address

310 S Greenleaf St Ste 203
Gurnee, IL 60031-5708

Phone

(847) 623-5915

Fax

(847) 623-1174

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 14, 2015 through Dec 14, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northshore Star Facial Plastic Surgery LLC

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Deerfield, IL
  • NPI 1730930447
  NPD
• Premiere Anesthesia Group LLC

  • Certified Registered Nurse Anesthetist
  • Park Ridge, IL
  • NPI 1720467392
  NPD (past)
• Walter Tatch, D.D.S., LTD.

  • Oral and Maxillofacial Surgery (Dentist)
  • Gurnee, IL
  • NPI 1356423891
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1285714568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OSTERMAN AVE",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154375",
            "telephone_number": "847-623-5915",
            "fax_number": "847-623-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S GREENLEAF ST STE 203",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315708",
            "telephone_number": "847-623-5915",
            "fax_number": "847-623-1174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Hollister Dr Ste 280",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600485260",
            "country_code": "US",
            "telephone_number": "847-623-5915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 Osterman Ave",
            "address_purpose": "LOCATION",
            "city": "Deerfield",
            "state": "IL",
            "postal_code": "600154375",
            "country_code": "US",
            "telephone_number": "847-623-5915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATCH",
        "first_name": "WALTER",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002076",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "021002076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alma L. Tan Torres, PHD, OTRL
• Galo Lim Tan, MD
• Patrick Kevin Tan, PT, DPT
• Linda Tanni, APRN
• Marlene Juco Tanquilut, MD
• Mark Taylor, PT
• Marson Tenoso, MD
• Nirguna Thalla, M.D.
• The Center for Internal Medicine and Preventive Care S C
• The Family Dentists LTD

• Oral & Maxillofacial Surgery (D.M.D.) in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.