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General NPI Number Information
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NPI Number | 1790865418
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Entity Type | Individual
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Provider Name | STEVAN WALKOWSKI D.O
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 191 W UNION ST STE 127
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City | ATHENS
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State | OH
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Zip | 45701-2732
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Country | US
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Telephone | 740-592-7010
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Fax | 740-592-7011
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Provider Business Mailing Address
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Address Line | 191 W UNION ST STE 127
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City | ATHENS
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State | OH
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Zip | 45701-2732
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Country | US
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Telephone | 740-592-7010
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Fax | 740-592-7011
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 34005061
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 34.005061CRT
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License Number State | OH
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