Provider Demographics
NPI:1053379834
Name:WALKER, WENDY H (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:H
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 M 119
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9586
Mailing Address - Country:US
Mailing Address - Phone:231-622-6570
Mailing Address - Fax:231-348-2009
Practice Address - Street 1:8881 M 119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740
Practice Address - Country:US
Practice Address - Phone:231-622-6570
Practice Address - Fax:231-348-2009
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802400761OtherBCBS PIN
MI4120867 10Medicaid
MIP91915OtherBLUE CARE NETWORK #
MI080B410330OtherBCBS GROUP BILLING #
0M80470Medicare ID - Type Unspecified
MI4120867 10Medicaid