Healthcare Provider Details

I. General information

NPI: 1427013614
Provider Name (Legal Business Name): JAMES P WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 CLINICAL DR CL 459
INDIANAPOLIS IN
46202-5233
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0550
  • Fax:
Mailing address:
  • Phone: 317-962-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01043582A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01043582
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: