MEDICARE: CHRISTINA M MITCHEM-WALTER 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	35083188	OH
2	208000000X	Pediatrics Physician	35083188	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	:	1992789853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA M MITCHEM-WALTER MD

Provider Business Mailing Address
First Line	:	1 TURTLE CREEK CIR
Second Line	:	STE F
City	:	SWANTON
State	:	OH
Zip	:	43558-8537
Country	:	US
Telephone Number	:	419-825-5151
Fax Number	:	419-825-5901

Provider Business Practice Location Address
First Line	:	1 TURTLE CREEK CIR
Second Line	:	STE F
City	:	SWANTON
State	:	OH
Zip	:	43558-8537
Country	:	US
Telephone Number	:	419-825-5151
Fax Number	:	419-825-5901

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/31/2012

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