Wallace, Adam N
Wallace, Adam N is an individual health care provider with primary practice located at 8201 East Riverside Boulevard Mercy Health Javon Bae Hospital, Rockford IL 61114-2300. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuroradiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neuroradiology is his primary health care specialty. Wallace, Adam N can be contacted via phone (815) 971-5000.Contact Information
Primary practice address
8201 East Riverside Boulevard Mercy Health Javon Bae Hospital
Rockford IL 61114-2300
Phone: (815) 971-5000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 70505-20 | Wisconsin |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 61898 | Minnesota |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | DR.0068906 | Colorado |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 2015013114 | Missouri |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 319983 | New York |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 036.148822 | Illinois |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 036.148822 | Illinois |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 70505 | Wisconsin |
Profile Details
| NPI number | 1801117585 |
|---|---|
| LBN Legal business name | Wallace, Adam N |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2010 |
| Last updated | Dec 15th, 2023 - about last year |
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 | 1801117585 | NPPES |
| Missouri | MEDICAID | 200021565 |
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