Individual
JOHN WALSTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
551 LINN ST, ALLEGAN, MI 49010-1595
(269) 686-5800
(269) 686-5899
Mailing address
551 LINN ST, ALLEGAN, MI 49010-1595
(269) 686-5800
(269) 686-5899
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
JW042924
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-30460
PHP PROV #
—
01
—
0800300041
BCBS MI PROV #
MI
01
—
080067212
RAILROAD MEDICARE
—
05
—
1353542
—
MI
01
—
1837425
UNITED HEALTHCARE
—
01
—
20476
HEALTH PLAN OF MI
MI
01
—
25685
COMMUNITY CHOICE OF MI
MI
01
—
JW042924
STATE LINCENSE #
MI
01
—
P00361391
RAILROAD MEDICARE
MI
01
—
P53510
BLUE CARE NETWORK
MI
Enumeration date
11/04/2005
Last updated
03/12/2015
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