Healthcare Provider Details

I. General information

NPI: 1720246572
Provider Name (Legal Business Name): WALTER J FILIPEK MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MICHIGAN STREET # 318
SOUTH BEND IN
46601-1070
US

IV. Provider business mailing address

707 N MICHIGAN STREET # 318
SOUTH BEND IN
46601-1070
US

V. Phone/Fax

Practice location:
  • Phone: 574-288-8000
  • Fax: 574-288-8088
Mailing address:
  • Phone: 574-288-8000
  • Fax: 574-288-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number01024470B
License Number StateIN

VIII. Authorized Official

Name: WALTER J FILIPEK
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 574-288-8000