Provider Demographics
NPI:1982678314
Name:ANGLEMEYER, WALTER D (DO)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:D
Last Name:ANGLEMEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1953 WATERFALL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-8961
Mailing Address - Country:US
Mailing Address - Phone:574-773-4101
Mailing Address - Fax:574-773-5483
Practice Address - Street 1:1953 WATERFALL DR
Practice Address - Street 2:SUITE A
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-8961
Practice Address - Country:US
Practice Address - Phone:574-773-4101
Practice Address - Fax:574-773-5483
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000675A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100114470Medicaid
IN100114470Medicaid
IN184520ZMedicare ID - Type Unspecified