Organization
MOCO WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT WALTERS MD (MEMBER)
(773) 746-2964
Entity
Organization
Contact information
Practice address
6517 PERSIMMON TREE RD, CABIN JOHN, MD 20818-1216
(773) 746-2964
Mailing address
PO BOX 736198, DALLAS, TX 75373-6198
(773) 746-2964
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093098329
—
MI
Enumeration date
07/29/2021
Last updated
03/08/2022
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