Provider Demographics
NPI:1639183775
Name:ALBRECHT, WALTER ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:ERNEST
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2000 GREEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1598
Mailing Address - Country:US
Mailing Address - Phone:734-995-3764
Mailing Address - Fax:208-475-9028
Practice Address - Street 1:2000 GREEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1598
Practice Address - Country:US
Practice Address - Phone:734-995-3764
Practice Address - Fax:208-475-9028
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066390207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1609082Medicare PIN
MIM57650055Medicare PIN
MIH48011Medicare UPIN