Healthcare Provider Details

I. General information

NPI: 1497792238
Provider Name (Legal Business Name): STEVEN GARY WALVISCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 HEALTH PKWY
MOUNT PLEASANT MI
48858-8931
US

IV. Provider business mailing address

2935 HEALTH PKWY
MOUNT PLEASANT MI
48858-8931
US

V. Phone/Fax

Practice location:
  • Phone: 989-779-5270
  • Fax: 989-779-5279
Mailing address:
  • Phone: 989-779-5270
  • Fax: 989-779-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301053546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: