Provider Demographics
NPI:1396716544
Name:WALKIEWICZ, JOSEPH L (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:WALKIEWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-422-8400
Mailing Address - Fax:734-422-8563
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-422-8400
Practice Address - Fax:734-422-8563
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9887207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5824545OtherBCBSM
MI2918756Medicaid
MIF44008Medicare UPIN
MI2918756Medicaid