Wallace, Kevin H
Wallace, Kevin H is an sole proprietor health care provider with primary practice located at 1350 Hickory St , Melbourne FL 32901-3224. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Sleep Medicine, Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Wallace, Kevin H can be contacted via phone (321) 434-4225.Contact Information
Primary practice address
1350 Hickory St
Melbourne FL 32901-3224
Phone: (321) 434-4225
Fax: (321) 434-4247
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | ME81186 | Florida |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 207RS0012X | ME81186 | Florida |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | ME81186 | Florida |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | ME81186 | Florida |
Profile Details
| NPI number | 1033195631 |
|---|---|
| LBN Legal business name | Wallace, Kevin H |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 16th, 2005 |
| Last updated | Aug 26th, 2022 - 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 | 1033195631 | NPPES |
| Florida | MEDICAID | 014488700 |
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