Individual
MR. WALTER DOUGLAS KOLMODIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
14950 STATE ROAD 23, GRANGER, IN 46530-7564
(574) 259-9668
(574) 259-9671
Mailing address
14950 STATE ROAD 23, GRANGER, IN 46530-7564
(574) 259-9668
(574) 259-9671
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000902A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000262667
BLUE CROSS BLUE SHIELD
IN
Enumeration date
09/13/2005
Last updated
07/10/2024
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