Provider Demographics
NPI:1093944704
Name:WALTER R DRWAL PLLC
Entity Type:Organization
Organization Name:WALTER R DRWAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:DRWAL
Authorized Official - Suffix:
Authorized Official - Credentials:LP, PHD
Authorized Official - Phone:810-234-9036
Mailing Address - Street 1:3717 VAN SLYKE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1497
Mailing Address - Country:US
Mailing Address - Phone:810-234-9036
Mailing Address - Fax:
Practice Address - Street 1:3717 VAN SLYKE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1497
Practice Address - Country:US
Practice Address - Phone:810-234-9036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013082251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health