Provider Demographics
NPI:1437153095
Name:WALKER, CHARLES J (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-7584
Mailing Address - Fax:317-957-2705
Practice Address - Street 1:3660 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1697
Practice Address - Country:US
Practice Address - Phone:317-920-7139
Practice Address - Fax:317-920-7229
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35362-0212085R0202X
IN02004140A2085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30064200Medicaid
INP01424274OtherRAIL ROAD PTAN
IN201136420Medicaid
IN201136420Medicaid
IN266180443Medicare PIN