Provider Demographics
NPI:1376519033
Name:WALKER, KENT D (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:D
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1005 PENNSYLVANIA AVE
Practice Address - Street 2:STE 210
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6414
Practice Address - Country:US
Practice Address - Phone:641-683-3195
Practice Address - Fax:641-686-3197
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA29726207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAF26001Medicare UPIN
IA0420471Medicaid
I7858Medicare ID - Type Unspecified