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General NPI Number Information
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NPI Number | 1568413482
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Entity Type | Individual
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Provider Name | MARIE G WALSH MD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 1985 GRATIOT AVE SUITE 2A
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City | MARYSVILLE
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State | MI
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Zip | 48040-1200
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Country | US
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Telephone | 810-364-5050
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Fax | 810-364-5688
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Provider Business Mailing Address
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Address Line | PO BOX 1239
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City | TROY
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State | MI
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Zip | 48099-1239
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Country | US
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Telephone | 248-824-6600
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Fax | 248-324-1477
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301074465
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License Number State | MI
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