Provider Demographics
NPI:1346240918
Name:CULVER, WALTER HARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:HARRY
Last Name:CULVER
Suffix:
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 1:1854 W AUBURN RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3868
Mailing Address - Country:US
Mailing Address - Phone:248-696-3170
Mailing Address - Fax:248-696-3175
Practice Address - Street 1:1854 W AUBURN RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3868
Practice Address - Country:US
Practice Address - Phone:248-696-3170
Practice Address - Fax:248-696-3175
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWC058404207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3173777Medicaid
MIG14686Medicare UPIN
MIOF37298024Medicare ID - Type UnspecifiedMEDICARE