Individual
LARISSA C DAY WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11725 N ILLINOIS STREET, SUITE 595, CARMEL, IN 46032-0052
(317) 688-5522
(317) 688-5533
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01068078A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200982230
—
IN
Enumeration date
05/14/2008
Last updated
07/21/2014
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