Healthcare Provider Details

I. General information

NPI: 1598788424
Provider Name (Legal Business Name): MICHAEL L WALTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N KING ST
HONOLULU HI
96817-4544
US

IV. Provider business mailing address

915 N KING ST
HONOLULU HI
96817-4544
US

V. Phone/Fax

Practice location:
  • Phone: 808-848-1438
  • Fax: 808-843-7270
Mailing address:
  • Phone: 808-848-1438
  • Fax: 808-843-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-10196
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: