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General NPI Number Information
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NPI Number | 1629096359
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Entity Type | Individual
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Provider Name | MICHAEL J WALTER MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 6812 STATE ROUTE 162 STE 202
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City | MARYVILLE
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State | IL
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Zip | 62062-8562
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Country | US
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Telephone | 618-288-6844
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Fax | 618-288-6852
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Provider Business Mailing Address
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Address Line | 6810 STATE ROUTE 162 BOX 215
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City | MARYVILLE
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State | IL
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Zip | 62062
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Country | US
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Telephone | 618-391-6495
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Fax |
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 103849
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 103849
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License Number State | MO
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