Provider Demographics
NPI:1992720254
Name:WALKER, EZELLE HARRY (MD)
Entity type:Individual
Prefix:
First Name:EZELLE
Middle Name:HARRY
Last Name:WALKER
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 1:2816 E 116TH ST
Mailing Address - Street 2:METROHEALTH BUCKEYE HEALTH CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2111
Mailing Address - Country:US
Mailing Address - Phone:216-957-1703
Mailing Address - Fax:
Practice Address - Street 1:2816 E 116TH ST
Practice Address - Street 2:METROHEALTH BUCKEYE HEALTH CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2111
Practice Address - Country:US
Practice Address - Phone:216-957-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0576158Medicaid
OH0576158Medicaid
OHF55521Medicare UPIN