Provider Demographics
NPI:1467432716
Name:WALKER, MICHAEL JON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:WALKER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 2ND ST NE
Mailing Address - Street 2:#580
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2417
Mailing Address - Country:US
Mailing Address - Phone:612-804-6061
Mailing Address - Fax:612-395-5595
Practice Address - Street 1:1515 SAINT FRANCIS AVE
Practice Address - Street 2:#100
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-403-3535
Practice Address - Fax:952-403-3599
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN39710208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32369500Medicaid
WI32369500Medicaid