Provider Demographics
NPI:1295727774
Name:MEEKER, WALTER K (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:K
Last Name:MEEKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3643 W FRONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7759
Mailing Address - Country:US
Mailing Address - Phone:231-935-0614
Mailing Address - Fax:231-935-0832
Practice Address - Street 1:3643 W FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-0614
Practice Address - Fax:231-935-0832
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104651842Medicaid
MI0N97750Medicare ID - Type Unspecified
MI104651842Medicaid