Healthcare Provider Details

I. General information

NPI: 1922669431
Provider Name (Legal Business Name): ARI PHILIP WALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 RIVERBEND RD STE A
BOULDER CO
80301-2640
US

IV. Provider business mailing address

650 STEWART RD
MONROE MI
48162-4222
US

V. Phone/Fax

Practice location:
  • Phone: 720-279-9098
  • Fax:
Mailing address:
  • Phone: 734-240-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301506226
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351045646
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351045646
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number4301506226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: