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NPI Code Detail

MEDICARE: DR. CHRISTINE DIANE WALLER DO

MEDICARE: DR. CHRISTINE DIANE WALLER DO
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
1207P00000XEmergency Medicine PhysicianBO9667710-705-41OH
2207P00000XEmergency Medicine Physician02003516AIN

General Provider Information

NPI Number : 1346453552
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTINE DIANE WALLER DO
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 114 EXECUTIVE DR STE E
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-4875
Country : US
Telephone Number : 765-446-0170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 02/03/2022

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Directions to “ DR. CHRISTINE DIANE WALLER DO” Practice Location

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