Healthcare Provider Details

I. General information

NPI: 1881822237
Provider Name (Legal Business Name): MICHAEL PATRICK WALSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28800 RYAN RD STE 310
WARREN MI
48092
US

IV. Provider business mailing address

28800 RYAN RD STE 310
WARREN MI
48092-4273
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-2867
  • Fax:
Mailing address:
  • Phone: 586-558-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301094853
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301094853
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: