MEDICARE: DR. WALTER R WOODHOUSE MD

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	207Q00000X	Family Medicine Physician	WW045624	MI

General Provider Information

NPI Number	:	1669460283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER R WOODHOUSE MD

Provider Business Mailing Address
First Line	:	9050 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1608
Country	:	US
Telephone Number	:	734-850-8902
Fax Number	:	734-850-8934

Provider Business Practice Location Address
First Line	:	9050 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1608
Country	:	US
Telephone Number	:	734-850-8902
Fax Number	:	734-850-8934

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	12/18/2016

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