Healthcare Provider Details

I. General information

NPI: 1669711727
Provider Name (Legal Business Name): ASHLEY MAE WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MAE RADKE M.D.

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 16TH ST
BAY CITY MI
48708-7609
US

IV. Provider business mailing address

2110 16TH ST
BAY CITY MI
48708-7609
US

V. Phone/Fax

Practice location:
  • Phone: 989-892-2517
  • Fax:
Mailing address:
  • Phone: 989-892-2517
  • Fax: 989-892-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301504354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: