Kyle Mark Walkowiak, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006155 Issued in MI

Practice address

1105 Sixth St
Traverse City, MI 49684-2345

Phone

(231) 947-0673

Fax

(801) 740-2847

NPI assigned

Sep 13, 2011

Last updated

Jul 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Caberfae Emergency Group, P.C.

  • Emergency Medicine Physician
  • Cadillac, MI
  • NPI 1447932504
  Medicare reassignment
• Hawk Emergency Group, P.C.

  • Emergency Medicine Physician
  • Charlevoix, MI
  • NPI 1073295135
  Medicare reassignment
• Interlochen Emergency Group, P.C.

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1336821495
  Medicare reassignment
• Northwestern Michigan Emergency Physicians PC

  • Emergency Medicine Physician
  • Traverse City, MI
  • NPI 1073597944
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1063794469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 N SPIDER LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496968440",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKOWIAK",
        "first_name": "KYLE",
        "middle_name": "MARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-13",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathi R Walker, PHARMD
• Craig Michael Walker, RPH
• David Alan Walker, D.O.
• M Marie Walker
• Christine E Walkowiak, PA
• Grace Wallace, PT, DPT
• Randall Thomas Wallace
• Chelsey Ann Waller, CNM, WHNP
• Melissa Wallington, OTR/L
• Katheryn Rae Wallison

• Physician Assistant in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.