Provider Demographics
NPI:1912009580
Name:WALTER, JAMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8020 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2029
Mailing Address - Country:US
Mailing Address - Phone:810-653-4145
Mailing Address - Fax:810-653-1741
Practice Address - Street 1:8020 DAVISON RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2029
Practice Address - Country:US
Practice Address - Phone:810-653-4145
Practice Address - Fax:810-653-1741
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235815Medicaid
MIM23560056Medicare PIN
MI3235815Medicaid