Individual
HEATHER WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10000 TELEGRAPH RD, EMERGENCY MEDICINE DEPARTMENT, TAYLOR, MI 48180-3330
(313) 295-5007
(313) 295-6725
Mailing address
38935 ANN ARBOR RD, CREDENTIALING/PAYER CONTRACTING, LIVONIA, MI 48150-3397
(734) 805-0477
(866) 250-6385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301090081
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12130578
CAQH
MI
05
—
1336349802
—
MI
Enumeration date
07/23/2007
Last updated
03/16/2012
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