Provider Demographics
NPI:1316975089
Name:WALTER, KEVIN D (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3365 S 103RD ST
Mailing Address - Street 2:GREENWAY MEDICAL CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4161
Mailing Address - Country:US
Mailing Address - Phone:414-604-7501
Mailing Address - Fax:414-604-7506
Practice Address - Street 1:3365 S 103RD ST
Practice Address - Street 2:GREENWAY MEDICAL CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4161
Practice Address - Country:US
Practice Address - Phone:414-604-7501
Practice Address - Fax:414-604-7506
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-02-15
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Provider Licenses
StateLicense IDTaxonomies
WI41518-020208000000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316975089Medicaid
H39657Medicare UPIN
WI68086 0814Medicare PIN
WI1316975089Medicaid