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NPI Code Detail

MEDICARE: DR. WALTER MICHAEL BAKUN MD

MEDICARE: DR. WALTER MICHAEL BAKUN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianMA45488NJ

General Provider Information

NPI Number : 1093812539
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WALTER MICHAEL BAKUN MD
Provider Business Mailing Address
First Line : 59 KOCH AVE
Second Line :
City : MORRIS PLAINS
State : NJ
Zip : 07950-4400
Country : US
Telephone Number : 973-538-1800
Fax Number : 973-889-8789
Provider Business Practice Location Address
First Line : 59 KOCH AVE
Second Line :
City : MORRIS PLAINS
State : NJ
Zip : 07950-4400
Country : US
Telephone Number : 973-539-1800
Fax Number : 973-889-8789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2006
Last Update Date : 02/25/2009

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