Wallace, Jonathan

Wallace, Jonathan is an individual health care provider with primary practice located at 4885 Hoffman Blvd Suite 400, Hoffman Estates IL 60192-3726. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Wallace, Jonathan can be contacted via phone (847) 255-9697.

Contact Information

Primary practice address
4885 Hoffman Blvd Suite 400 Hoffman Estates IL 60192-3726
Phone: (847) 255-9697
Fax: (847) 255-9697
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 036108563 Illinois
Allopathic & Osteopathic Physicians / Surgery 208600000X 036108563 Illinois

Profile Details

NPI number 1568422012
LBN Legal business name Wallace, Jonathan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2006
Last updated Mar 19th, 2021 - about 3 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 1568422012 NPPES
Illinois MEDICAID 036108563

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