=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841236411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN M. WALSH, DPM, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2006
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 MICHIGAN AVE
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48040-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-364-6614
-----------------------------------------------------
Fax | 810-364-6615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 MICHIGAN AVE
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48040-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-364-6614
-----------------------------------------------------
Fax | 810-364-6615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREN MARIE WALSH
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 810-364-6614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | KW001963
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------