Provider Demographics
NPI:1437241221
Name:WALKER, NICHOLAS E (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
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 1:200 HAWKINS DR
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-339-3883
Mailing Address - Fax:319-339-3882
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-339-3883
Practice Address - Fax:319-339-3882
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35043207RC0000X, 207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20242Medicare PIN
IA04519OtherWELLMARK
P00435168OtherRR MEDICARE
71960OtherMEDICARE GROUP
CA3899OtherRR MEDICARE GROUP
MEMBERP00741014OtherRR MEDICARE
IA0767244Medicaid