Provider Demographics
NPI:1558470062
Name:WALKER, DAVID ALAN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MUNSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3580
Mailing Address - Country:US
Mailing Address - Phone:231-935-9275
Mailing Address - Fax:231-935-9280
Practice Address - Street 1:550 MUNSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3580
Practice Address - Country:US
Practice Address - Phone:231-935-9275
Practice Address - Fax:231-935-9280
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW007582207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID72657OtherPRIORITY HEALTH #
MI112572982Medicaid
MIC4739OtherMCARE #
MIP00068149OtherRR MEDICARE PIN
MI290B810560OtherBLUE CROSS #
MIDA6917OtherRAILROAD MR #