Provider Demographics
NPI:1841250057
Name:WALTER, LAWRENCE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2130 BIG BEND RD
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7624
Mailing Address - Country:US
Mailing Address - Phone:262-928-7555
Mailing Address - Fax:262-928-7575
Practice Address - Street 1:2130 BIG BEND RD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7624
Practice Address - Country:US
Practice Address - Phone:262-928-7555
Practice Address - Fax:262-928-7575
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS11795207QS0010X
WI56264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400117202Medicare PIN