MEDICARE: DR. SEAN S WALCOTT 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	207P00000X	Emergency Medicine Physician	4301078051	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11311888	OTHER	MI	CAQH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609854611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN S WALCOTT MD

Provider Business Mailing Address
First Line	:	PO BOX 638257
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-8257
Country	:	US
Telephone Number	:	888-952-6772
Fax Number	:	856-694-5179

Provider Business Practice Location Address
First Line	:	33155 ANNAPOLIS ST
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-2405
Country	:	US
Telephone Number	:	734-467-4000
Fax Number	:

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/22/2025

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