Provider Demographics
NPI:1932210713
Name:WALSH, JON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST # 67
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6022
Mailing Address - Fax:269-341-8244
Practice Address - Street 1:601 JOHN ST # 67
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6022
Practice Address - Fax:269-341-8244
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076772208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932210713Medicaid
MI1417961137OtherBCBSM - BRONSON
MIC97618182 - BRONSONMedicare PIN
MI1417961137OtherBCBSM - BRONSON
MI1932210713Medicaid