Healthcare Provider Details

I. General information

NPI: 1265971246
Provider Name (Legal Business Name): WALKER WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 E JEFFERSON AVE SUITE 250
GROSSE POINTE MI
48230-1923
US

IV. Provider business mailing address

16815 E JEFFERSON AVE SUITE 250
GROSSE POINTE MI
48230-1923
US

V. Phone/Fax

Practice location:
  • Phone: 516-286-2240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5101015379
License Number StateMI

VIII. Authorized Official

Name: ANGELA WALKER
Title or Position: OWNER
Credential: DO
Phone: 516-286-2240