Provider Demographics
NPI:1568445245
Name:WALSH, MICHAEL KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:WALSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3946 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-9702
Mailing Address - Country:US
Mailing Address - Phone:315-624-8300
Mailing Address - Fax:315-624-8310
Practice Address - Street 1:3946 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-9702
Practice Address - Country:US
Practice Address - Phone:315-624-8300
Practice Address - Fax:315-624-8310
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2015-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY239712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02755282Medicaid
NY02755282Medicaid