Wallace, David Lee
Wallace, David Lee is an individual health care provider with primary practice located at 441 N Wabash Ave , Marion IN 46952-2612. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wallace, David Lee can be contacted via phone (765) 660-7600.Contact Information
Primary practice address
441 N Wabash Ave
Marion IN 46952-2612
Phone: (765) 660-7600
Fax: (765) 651-7313
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 01027186 | Indiana |
Profile Details
| NPI number | 1417996232 |
|---|---|
| LBN Legal business name | Wallace, David Lee |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2006 |
| Last updated | Oct 19th, 2012 - about 12 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 | 1417996232 | NPPES |
| Indiana | MEDICAID | 100066360 | |
| Indiana | Other | 000000530919 |
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