Provider Demographics
NPI:1093812539
Name:BAKUN, WALTER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:MICHAEL
Last Name:BAKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WALTER
Other - Middle Name:MICHAEL
Other - Last Name:BAKUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:59 KOCH AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-4400
Mailing Address - Country:US
Mailing Address - Phone:973-538-1800
Mailing Address - Fax:973-889-8789
Practice Address - Street 1:59 KOCH AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-4400
Practice Address - Country:US
Practice Address - Phone:973-539-1800
Practice Address - Fax:973-889-8789
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45488204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine