Individual
AMANDA MARIE WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1001 HADLEY RD # LL050, MOORESVILLE, IN 46158-1883
(317) 834-3502
(317) 834-3519
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01073953A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1513119530001
—
IN
Enumeration date
04/25/2011
Last updated
09/12/2023
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