Provider Demographics
NPI:1477538585
Name:WALTERS, MICHELLE COLLINS (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:COLLINS
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3131 S ZUNIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2232
Mailing Address - Country:US
Mailing Address - Phone:619-218-8358
Mailing Address - Fax:918-728-3376
Practice Address - Street 1:2424 E 21ST ST STE 340
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1722
Practice Address - Country:US
Practice Address - Phone:918-728-3100
Practice Address - Fax:918-728-3376
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059900A207N00000X
VA0101252959207N00000X
OK38685207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology