Provider Demographics
NPI:1063482115
Name:WALSH, THOMAS E (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521
Mailing Address - Country:US
Mailing Address - Phone:785-889-7193
Mailing Address - Fax:
Practice Address - Street 1:716 HIGH STREET
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521
Practice Address - Country:US
Practice Address - Phone:785-889-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082860AMedicaid
KS100082860AMedicaid
KS053810Medicare UPIN