Provider Demographics
NPI:1891875647
Name:WALKER, ROLAND HAYES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:HAYES
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N VERMILLION ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1541
Mailing Address - Country:US
Mailing Address - Phone:219-939-8970
Mailing Address - Fax:
Practice Address - Street 1:601 W KIEFFER RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9599
Practice Address - Country:US
Practice Address - Phone:219-210-3676
Practice Address - Fax:219-939-6090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060204A208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811740AMedicaid
INI29158Medicare UPIN
IN200811740AMedicaid