Individual
DR. MARK J. WALTERSKIRCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1965 S FREMONT AVE, SUITE 370, SPRINGFIELD, MO 65804-2201
(417) 820-0300
(417) 882-9645
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
2000155025
MO
208800000X
Urology Physician
Primary
MD00048487
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083637524
NPI #
MO
05
—
204964605
—
MO
01
—
340017773
RR MEDICARE PROV. #
MO
Enumeration date
07/25/2006
Last updated
01/15/2026
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