Provider Demographics
NPI:1750330593
Name:FILIPEK, WALTER JAMES (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:FILIPEK
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 1:707 N. MICHIGAN ST
Mailing Address - Street 2:# 318
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1070
Mailing Address - Country:US
Mailing Address - Phone:574-288-8000
Mailing Address - Fax:574-288-8088
Practice Address - Street 1:707 N. MICHIGAN ST
Practice Address - Street 2:# 318
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1070
Practice Address - Country:US
Practice Address - Phone:574-288-8000
Practice Address - Fax:574-288-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024470B207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186060AMedicaid
IN000000213208OtherBLUE CROSS BLUE SHIELD
FI 561360Medicare ID - Type Unspecified
INC25382Medicare UPIN