Individual
DR. JERRY SAMUEL WALDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3174 PACKARD ST, ANN ARBOR, MI 48108-1947
(734) 971-1073
(734) 971-8545
Mailing address
3174 PACKARD ST, ANN ARBOR, MI 48108-1947
(734) 971-1073
(734) 971-8545
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
JW027573
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0808172651
BCBS
MI
01
—
0817265
BLUE CARE NETWORK
MI
01
—
103791
CARE CHOICES
MI
05
—
1639933
—
MI
01
—
B45555
HAP
MI
01
—
C-2855
M-CARE
MI
Enumeration date
08/30/2006
Last updated
07/09/2007
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