Healthcare Provider Details

I. General information

NPI: 1942208749
Provider Name (Legal Business Name): JOHN J WALPER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MICHIGAN AVE STE 300
JACKSON MI
49201-1853
US

IV. Provider business mailing address

1201 E. MICHIGAN AVE. #300
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1431
  • Fax: 517-205-1432
Mailing address:
  • Phone: 517-205-1431
  • Fax: 517-205-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301059688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: