Individual
MRS. TRICIA A WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1750
(574) 647-1748
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01065500A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200928780A
—
IN
Enumeration date
07/05/2007
Last updated
04/28/2023
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