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DR. BRENT MICHAEL WALZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1220 SPRING ST, JEFFERSONVILLE, IN 47130-3704
(812) 282-8494
(812) 280-3030
Mailing address
PO BOX 776351, CHICAGO, IL 60677-3704
(502) 559-9337
(502) 272-5339

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01060263A
IN
207X00000X
Orthopaedic Surgery Physician
39291
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000365692
IN BC
IN
01
1720078900
NPI
IN
05
200354700A
IN
05
7100620820
KY
01
IN2570009
MEDICARE
IN
Enumeration date
10/27/2005
Last updated
04/02/2024
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