MEDICARE: FALLON WALKER

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1598611394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALLON WALKER

Provider Business Mailing Address
First Line	:	14929 GRIGGS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-1610
Country	:	US
Telephone Number	:	313-942-5613
Fax Number	:

Provider Business Practice Location Address
First Line	:	14929 GRIGGS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-1610
Country	:	US
Telephone Number	:	313-942-5613
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ FALLON WALKER ” Practice Location

Language	Start Address	Practice Location

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