Provider Demographics
NPI:1699547794
Name:WALZ, KEVIN MICHAEL
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:WALZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3317
Mailing Address - Country:US
Mailing Address - Phone:412-692-2273
Mailing Address - Fax:
Practice Address - Street 1:10 CARRICK AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-4322
Practice Address - Country:US
Practice Address - Phone:412-954-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA175T00000X175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist