Provider Demographics
NPI:1568413482
Name:WALSH, MARIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:G
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1985 GRATIOT AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1200
Practice Address - Country:US
Practice Address - Phone:810-364-5050
Practice Address - Fax:810-364-5688
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4872208-10Medicaid
MI1568413482OtherNPI #
MI0D40029OtherBCBS GROUP PIN FOR LAPEER
MI1609101807OtherNPI GROUP
MIMA074465OtherSTATE ID
MI70-0-F32947-0OtherBCBS CPIN #
MI1106323752OtherBCBS ID
MI1106323752OtherBCBS ID
MI1609101807OtherNPI GROUP