MEDICARE: MRS. CATHERINE ANN WALLER M.D.

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	4301047652	MI

General Provider Information

NPI Number	:	1639292832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE ANN WALLER M.D.

Provider Business Mailing Address
First Line	:	5757 PAINT VALLEY DR
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48306-2466
Country	:	US
Telephone Number	:	248-656-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 W AUBURN RD
Second Line	:	STE. 400
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3868
Country	:	US
Telephone Number	:	248-844-1414
Fax Number	:	248-844-2670

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/07/2023

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