Individual
RANDALL R. WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 19401 HUBBARD DRIVE, DEARBORN, MI 48126
(313) 982-8370
(313) 982-8165
Mailing address
HENRY FORD HEALTH SYSTEM, 19401 HUBBARD DRIVE, DEARBORN, MI 48126
(313) 982-8370
(313) 982-8165
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301041028
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137318910
—
MI
01
—
700H262300
BLUE CROSS-BLUE CROSS
—
01
—
RW041028
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
12/01/2006
Last updated
05/14/2008
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