MEDICARE: DR. JOHN E. WALZ 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
1	174400000X	Specialist	21885	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	391415680-00	OTHER	WI	UNITY HEALTH PLAN
2	1005999	OTHER	WI	PHYSICIANS PLUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	391415680019	OTHER	WI	BLUE CROSS
5	391415680-01	OTHER	WI	HERITAGE/JOHN DEERE
6	538607	OTHER	WI	DEAN HEALTH PLAN

General Provider Information

NPI Number	:	1225088362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E. WALZ MD

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	COLUMBUS
State	:	WI
Zip	:	53925-0370
Country	:	US
Telephone Number	:	920-623-3040
Fax Number	:	920-623-2244

Provider Business Practice Location Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	WI
Zip	:	53925-2401
Country	:	US
Telephone Number	:	920-623-3040
Fax Number	:	920-623-2244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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