Healthcare Provider Details

I. General information

NPI: 1831695642
Provider Name (Legal Business Name): JAMES GRANT WALTHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16408 JEANIE DRIVE
AURORA IN
45014
US

IV. Provider business mailing address

16408 JEANIE DRIVE
AURORA IN
45014
US

V. Phone/Fax

Practice location:
  • Phone: 513-702-0261
  • Fax:
Mailing address:
  • Phone: 513-702-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: