Provider Demographics
NPI:1841347184
Name:WALTER, HENRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE G1-11
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-8121
Practice Address - Fax:502-636-8128
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY21554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64215544Medicaid
KY100016220Medicaid
KY119014OtherSIHO- NCMA
KY50031914OtherPASSPORT- NCMA
KYP00912083OtherRAILROAD MEDICARE- NCMA
KY000057043VOtherHUMANA- NCMA
KY2543254OtherCIGNA- NCMA
KY692787OtherANTHEM- NCMA
KY692787OtherANTHEM- NCMA
KYP00912083OtherRAILROAD MEDICARE- NCMA