Anderson, Wallace M
Anderson, Wallace M is an individual health care provider with primary practice located at 800 E Carpenter St , Springfield IL 62769-5360. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Anderson, Wallace M can be contacted via phone (217) 544-6464.Contact Information
Primary practice address
800 E Carpenter St
Springfield IL 62769-5360
Phone: (217) 544-6464
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 36082306 | Illinois |
Profile Details
| NPI number | 1578510913 |
|---|---|
| LBN Legal business name | Anderson, Wallace M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 30th, 2006 |
| Last updated | Jan 30th, 2024 - about 8 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578510913 | NPPES |
| Illinois | MEDICAID | 0360823063 | |
| Illinois | Other | 1333997 |
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