Healthcare Provider Details

I. General information

NPI: 1437153095
Provider Name (Legal Business Name): CHARLES J. WALKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 GUION RD
INDIANAPOLIS IN
46222-1697
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-920-7139
  • Fax: 317-920-7229
Mailing address:
  • Phone: 317-621-7584
  • Fax: 317-957-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35362-021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number02004140A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02004140A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: