MEDICARE: CHARLES J. WALKER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	35362-021	WI
2	2085R0202X	Diagnostic Radiology Physician	02004140A	IN
3	208D00000X	General Practice Physician	02004140A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P01424274	OTHER	IN	RAIL ROAD PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437153095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES J. WALKER DO

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	STE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:	317-621-7584
Fax Number	:	317-957-2705

Provider Business Practice Location Address
First Line	:	3660 GUION RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1697
Country	:	US
Telephone Number	:	317-920-7139
Fax Number	:	317-920-7229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/27/2015

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Directions to “ CHARLES J. WALKER DO” Practice Location

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