Individual
DR. ERIC THOMAS WALCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2122 HEALTH DR SW, WYOMING, MI 49519-9698
(616) 252-5950
(616) 252-5956
Mailing address
985 GEZON PKWY SW, ATTN: TERESA MCNALLY, WYOMING, MI 49509-9563
(616) 252-4655
(616) 252-0103
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
5101013546
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4618795
—
MI
01
—
5101013546
STATE LICENSE
MI
01
—
EW013546
BCBSM PIN
MI
01
—
P00145080
RAILROAD MEDICARE
MI
Enumeration date
11/03/2005
Last updated
10/17/2017
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