Wallace, David
Wallace, David is an individual health care provider with primary practice located at 340 W Lincoln St , Belleville IL 62220-1900. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Wallace, David can be contacted via phone (618) 233-6044.Contact Information
Primary practice address
340 W Lincoln St
Belleville IL 62220-1900
Phone: (618) 233-6044
Fax: (618) 233-3287
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 036092919 | Illinois |
Profile Details
| NPI number | 1609804525 |
|---|---|
| LBN Legal business name | Wallace, David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 29th, 2006 |
| Last updated | Apr 17th, 2017 - about 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609804525 | NPPES |
| Illinois | MEDICAID | 0360929191 | |
| Illinois | Other | 107076 | |
| Illinois | Other | 2501200 | |
| Illinois | Other | 37099690008 | |
| Illinois | Other | E43629 | |
| Illinois | Other | 12269 | |
| Illinois | Other | 060046618 | |
| Illinois | Other | 1734162 | |
| Illinois | MEDICAID | 205943608 | |
| Illinois | Other | 235649 | |
| Illinois | Other | 235649 | |
| Illinois | Other | 093355 | |
| Illinois | Other | 54656 | |
| Illinois | Other | P01024928 |
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