Wallace, Gabriel Abraham
Wallace, Gabriel Abraham is an sole proprietor health care provider with primary practice located at 12251 S 80Th Ave Ste 1520 , Palos Heights IL 60463-1290. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Wallace, Gabriel Abraham can be contacted via phone (708) 923-4200.Contact Information
Primary practice address
12251 S 80Th Ave Ste 1520
Palos Heights IL 60463-1290
Phone: (708) 923-4200
Fax: (708) 923-4201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 036142476 | Illinois |
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | 036142476 | Illinois |
Profile Details
| NPI number | 1609142074 |
|---|---|
| LBN Legal business name | Wallace, Gabriel Abraham |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 29th, 2012 |
| Last updated | Aug 31st, 2023 - about 2 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 | 1609142074 | NPPES |
| Illinois | MEDICAID | 036142476 |
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