Provider Demographics
NPI:1477243228
Name:WALTERS, MITCHELL C JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:C JOSEPH
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-859-7222
Mailing Address - Fax:317-859-4269
Practice Address - Street 1:8240 NAAB RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1986
Practice Address - Country:US
Practice Address - Phone:317-890-2000
Practice Address - Fax:317-876-2320
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2024-01-19
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Provider Licenses
StateLicense IDTaxonomies
IN10004038A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant