Provider Demographics
NPI:1790865418
Name:WALKOWSKI, STEVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVAN
Middle Name:
Last Name:WALKOWSKI
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 1:191 W UNION ST STE 127
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2732
Mailing Address - Country:US
Mailing Address - Phone:740-592-7010
Mailing Address - Fax:740-592-7011
Practice Address - Street 1:191 W UNION ST STE 127
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2732
Practice Address - Country:US
Practice Address - Phone:740-592-7010
Practice Address - Fax:740-592-7011
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005061208D00000X
OH34.005061CRT204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0834360Medicaid
OHBW2374217OtherDEA NUMBER