Individual
WALTER J KANIEFSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 PARK ST, EMERGENCY MEDICINE DEPARTMENT, HONESDALE, PA 18431-1445
(570) 253-8140
(570) 253-8633
Mailing address
38935 ANN ARBOR RD, CREDENTIALING/PAYER CONTRACTING DEPT, LIVONIA, MI 48150-3397
(734) 805-0477
(866) 250-6385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101055974
VA
207P00000X
Emergency Medicine Physician
Primary
MD444759
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010295564
—
VA
01
—
10394151
CAQH
PA
05
—
PENDING
—
PA
Enumeration date
07/10/2006
Last updated
01/10/2012
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