Basic Information
| Provider Information | |||||||||
| NPI: | 1831127190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALBRIDGE | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALBRIDGE | ||||||||
| OtherFirstName: | D. | ||||||||
| OtherMiddleName: | JAY | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 125 S KALAMAZOO MALL | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490074832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693433900 | ||||||||
| FaxNumber: | 2693435640 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 S KALAMAZOO MALL | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490074832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693433900 | ||||||||
| FaxNumber: | 2693435640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 5101009004 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 11/2698492 | 05 | MI | MEDICAID | 11/2754180 | 05 | MI | MEDICAID | 11/4687068 | 05 | MI | MEDICAID |