Provider Demographics
NPI:1497732085
Name:WALTON, MICHAEL HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAROLD
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1618 COUNTY ROAD D
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:WI
Mailing Address - Zip Code:54756-8502
Mailing Address - Country:US
Mailing Address - Phone:715-946-3380
Mailing Address - Fax:
Practice Address - Street 1:2661 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5407
Practice Address - Country:US
Practice Address - Phone:715-726-3220
Practice Address - Fax:715-726-2297
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20016207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31323900Medicaid
WI28200OtherSECURITY HEALTH
A96099Medicare UPIN
WI0023Medicare PIN