Provider Demographics
NPI:1720180482
Name:WALSH MCPHERSON, DANIELLE M (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:M
Last Name:WALSH MCPHERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MI
Mailing Address - Zip Code:48659-9548
Mailing Address - Country:US
Mailing Address - Phone:989-654-2491
Mailing Address - Fax:989-654-2348
Practice Address - Street 1:725 E STATE ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9548
Practice Address - Country:US
Practice Address - Phone:989-654-2491
Practice Address - Fax:989-654-2348
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588986996OtherUNITEDHEALTHCARE / COMMUNITY HEALTH (GLH)
MI4731362Medicaid
MI1588986996OtherUNITEDHEALTHCARE
MI1720180482OtherAETNA
MI4731362Medicaid
MIM23560155Medicare PIN
MIMI2703004Medicare PIN