Provider Demographics
NPI:1184653990
Name:MONICA WALKER M.D. PA
Entity type:Organization
Organization Name:MONICA WALKER M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LEONOR
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-486-1404
Mailing Address - Street 1:395 COMMERCIAL CT
Mailing Address - Street 2:STE E
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1651
Mailing Address - Country:US
Mailing Address - Phone:941-486-1404
Mailing Address - Fax:941-486-4146
Practice Address - Street 1:395 COMMERCIAL CT
Practice Address - Street 2:STE E
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1651
Practice Address - Country:US
Practice Address - Phone:941-486-1404
Practice Address - Fax:941-486-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23614BMedicare ID - Type Unspecified
FLE30560Medicare UPIN