Individual
DR. HENRY LANE WALTERS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3901 BEAUBIEN ST, DETROIT, MI 48201-2119
(313) 745-5538
(313) 993-0531
Mailing address
PO BOX 441097, DETROIT, MI 48244-1097
(313) 745-6896
(313) 993-0531
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301059126
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
430105916
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0208211331
BCBS
MI
05
—
286376510
—
MI
Enumeration date
01/18/2006
Last updated
02/18/2009
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