Provider Demographics
NPI:1114087087
Name:KNYSZ, WALTER III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:KNYSZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LONG LAKE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2374
Mailing Address - Country:US
Mailing Address - Phone:248-290-1000
Mailing Address - Fax:
Practice Address - Street 1:300 E LONG LAKE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2374
Practice Address - Country:US
Practice Address - Phone:248-290-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010807642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry