Provider Demographics
NPI:1306819321
Name:WALKER, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-781-1183
Mailing Address - Fax:269-781-9248
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 3D
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-781-1183
Practice Address - Fax:269-781-9248
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056472174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0130103OtherBCBS
MI3131409Medicaid
MIP87680OtherBLUE CHOICE & BLUE CARE
MIF98038Medicare UPIN
MA0130103OtherBCBS