Healthcare Provider Details

I. General information

NPI: 1700498771
Provider Name (Legal Business Name): DARRYL ANGELO WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W GRAND BLVD
DETROIT MI
48208-2336
US

IV. Provider business mailing address

1121 E MCNICHOLS RD
DETROIT MI
48203-2857
US

V. Phone/Fax

Practice location:
  • Phone: 313-324-8900
  • Fax: 313-365-8701
Mailing address:
  • Phone: 313-365-3100
  • Fax: 313-365-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: