Provider Demographics
NPI:1083811830
Name:WALSH, MICHELE (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:393 E TOWN ST
Practice Address - Street 2:SUITE 116
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4741
Practice Address - Country:US
Practice Address - Phone:614-566-9108
Practice Address - Fax:614-566-8737
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42418207Q00000X
OH35122961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine