MEDICARE: EZELLE HARRY WALKER 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	207R00000X	Internal Medicine Physician	35045566	OH

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

General Provider Information

NPI Number	:	1992720254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZELLE HARRY WALKER MD

Provider Business Mailing Address
First Line	:	2816 E 116TH ST
Second Line	:	METROHEALTH BUCKEYE HEALTH CENTER
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2111
Country	:	US
Telephone Number	:	216-957-1703
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 E 116TH ST
Second Line	:	METROHEALTH BUCKEYE HEALTH CENTER
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2111
Country	:	US
Telephone Number	:	216-957-1703
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/28/2010

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