Provider Demographics
NPI:1780116517
Name:WALKER, MICHELLE PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PATRICIA
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD.
Mailing Address - Street 2:WEST PAVILION 4TH FL SUITE 4-900 W
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5134
Mailing Address - Country:US
Mailing Address - Phone:215-662-2300
Mailing Address - Fax:215-614-0418
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:WEST PAVILION 4TH FL SUITE 4-900 W
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5134
Practice Address - Country:US
Practice Address - Phone:215-662-2300
Practice Address - Fax:215-614-0418
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473568207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine