Provider Demographics
NPI:1013233071
Name:WALSH, KEVIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2580 HAYMAKER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3518
Mailing Address - Country:US
Mailing Address - Phone:412-858-7766
Mailing Address - Fax:412-858-7769
Practice Address - Street 1:2580 HAYMAKER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3518
Practice Address - Country:US
Practice Address - Phone:412-858-7766
Practice Address - Fax:412-858-7769
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2020-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD459550207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
14011367OtherCAQH
PA103302821Medicaid