Individual
LARRY R WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1220 WEST MILHAM AVE, PORTAGE, MI 49024-1206
(269) 382-9900
(269) 382-0700
Mailing address
1220 WEST MILHAM AVE, PORTAGE, MI 49024-1206
(269) 382-9900
(269) 382-0700
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
039773
MI
335E00000X
Prosthetic/Orthotic Supplier
039773
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039279
BCBS PROVIDER ID
MI
05
—
4079644
—
MI
Enumeration date
06/28/2006
Last updated
08/11/2011
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