Provider Demographics
NPI:1922897370
Name:OGLESBY, WALKER
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:
Last Name:OGLESBY
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 1:26695 W CARNEGIE PARK DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-6163
Mailing Address - Country:US
Mailing Address - Phone:248-727-5280
Mailing Address - Fax:
Practice Address - Street 1:33533 W 12 MILE RD STE 295
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5635
Practice Address - Country:US
Practice Address - Phone:248-406-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIO242866012086172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker