Wallis, Diane Elizabeth

Wallis, Diane Elizabeth is an individual health care provider with primary practice located at 3825 Highland Ave Suite 400, Downers Grove IL 60515-1552. She recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as her primary health care specialty. Wallis, Diane Elizabeth can be contacted via phone (630) 719-4799.

Contact Information

Primary practice address
3825 Highland Ave Suite 400 Downers Grove IL 60515-1552
Phone: (630) 719-4799
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 036061857 Illinois

Profile Details

NPI number 1659323574
LBN Legal business name Wallis, Diane Elizabeth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Nov 29th, 2016 - about 8 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 1659323574 NPPES
Illinois MEDICAID 036061857
Illinois Other 060043700

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