Randall R. Walter, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

4301041028 Issued in MI

Practice address

Henry Ford Health System
19401 Hubbard Drive
Dearborn, MI 48126

Phone

(313) 982-8370

Fax

(313) 982-8165

NPI assigned

Dec 1, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1275601916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HENRY FORD HEALTH SYSTEM",
            "address_2": "19401 HUBBARD DRIVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48126",
            "telephone_number": "313-982-8370",
            "fax_number": "313-982-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HENRY FORD HEALTH SYSTEM",
            "address_2": "19401 HUBBARD DRIVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48126",
            "telephone_number": "313-982-8370",
            "fax_number": "313-982-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "RANDALL",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301041028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137318910",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL-COMMERCIAL NUMBER",
            "identifier": "RW041028",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS-CHAMPUS",
            "identifier": "RW041028",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS-BLUE CROSS",
            "identifier": "700H262300",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kinyatta Walls
• Manisha Walls
• Angela Walsh, OTR
• Paige L Walsh
• Erich Werner Walter, DC
• Mary Jo Ann Walters, LPC
• Sahaj Wanchu, DO
• Cindy Wang, O.D.
• Brooke Wanshon, MS, RN, CPNP-PC
• Alan Warbelow, MA, LLP

• Diagnostic Radiology Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.