Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301104818 | MI |
Y | 2080P0204X | Pediatric Emergency Doctor | 10292173-1205 | UT |
NPI | 1265846158 |
---|---|
Provider Name | Kevin Walker |
First Address | Salt Lake City, UT 84158-1289 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 20/12/2021 |