Wallace, Amy Blaising

Wallace, Amy Blaising is an individual health care provider with primary practice located at 1415 S Main St , Eaton Rapids MI 48827-1959. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Wallace, Amy Blaising can be contacted via phone (517) 663-4809.

Contact Information

Primary practice address
1415 S Main St Eaton Rapids MI 48827-1959
Phone: (517) 663-4809
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 5101013086 Michigan

Profile Details

NPI number 1356380950
LBN Legal business name Wallace, Amy Blaising
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Dec 17th, 2018 - about 6 years 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356380950 NPPES
Michigan MEDICAID 1356380950
Michigan MEDICAID 4628183TYPE11

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