Provider Demographics
NPI:1841236411
Name:KAREN M. WALSH, DPM, PC
Entity Type:Organization
Organization Name:KAREN M. WALSH, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-364-6614
Mailing Address - Street 1:1100 MICHIGAN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2112
Mailing Address - Country:US
Mailing Address - Phone:810-364-6614
Mailing Address - Fax:810-364-6615
Practice Address - Street 1:1100 MICHIGAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2112
Practice Address - Country:US
Practice Address - Phone:810-364-6614
Practice Address - Fax:810-364-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKW001963213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4505540Medicaid
MI5500985OtherBLUE CROSS BLUE SHIELD MI
MI5500985OtherBLUE CROSS BLUE SHIELD MI
MI4795730001Medicare NSC
0P32680Medicare PIN