Individual
MARK JOSEPH WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 LAKEVIEW DR, LODI, OH 44254-1225
(330) 691-0919
Mailing address
650 LAKEVIEW DR, LODI, OH 44254-1225
(330) 691-0919
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
06/13/2025
Last updated
06/13/2025
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