Healthcare Provider Details

I. General information

NPI: 1417243528
Provider Name (Legal Business Name): BRETT MICHAEL WALKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N SHIAWASSEE ST STE 200
OWOSSO MI
48867-1601
US

IV. Provider business mailing address

819 N SHIAWASSEE ST STE 200
OWOSSO MI
48867-1601
US

V. Phone/Fax

Practice location:
  • Phone: 989-541-2663
  • Fax: 989-723-3601
Mailing address:
  • Phone: 989-541-2663
  • Fax: 989-723-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number5101019210
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberFW3427944
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101019210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: