Provider Demographics
NPI:1609845734
Name:WALSH, KEVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5169 COTTONWOOD ST
Mailing Address - Street 2:BLDG. B, SUITE 520
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-3500
Mailing Address - Fax:801-507-3550
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:BLDG. B, SUITE 520
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:801-507-3550
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT166974-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002084183Medicaid
UTO3848Medicaid
60015235OtherRR MEDICARE
WY101576100Medicaid
UT000010398Medicare PIN
60015235OtherRR MEDICARE