Healthcare Provider Details

I. General information

NPI: 1821140799
Provider Name (Legal Business Name): TERRANCE L WALSH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N ATKINSON DR SUITE 112
LUDINGTON MI
49431-1953
US

IV. Provider business mailing address

1273 N 72ND AVE
HART MI
49420-8914
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-3717
  • Fax: 231-845-6198
Mailing address:
  • Phone: 231-873-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601001538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: