DAVID KEITH WALLIS (NPI# 1134685167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134685167 |
| Entity Type | Individual |
| Full Name | DAVID KEITH WALLIS |
| Practice Address |
1400 E 12 Mile Rd Madison Heights MI 48071-2651 |
| Practice Telephone | 2486581116 |
| Practice Fax Number | 2486581120 |
| Mailing Telephone | 2486581116 |
| Mailing Fax Number | 2486581120 |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2019-02-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | MI | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255383139 | David Wallis | Internal Medicine | 3701 Skypark Dr, Suite 100, Torrance, CA 90505-4753 | 2006-05-17 |
| Street Address |
1400 E 12 MILE RD |
| City | MADISON HEIGHTS |
| State | MI |
| Zip Code | 48071-2651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972535474 | Millennium Treatment Services, LLC | Clinic/Center | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2006-07-07 |
| 1568940369 | Susan B Yahia | Social Worker | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2018-08-02 |
| 1760984165 | Laura Lan Schefke | Peer Specialist | 1400 E 12 Mile Rd, Madison Heights, MI 48071 | 2018-03-02 |
| 1356718985 | Mark Fras | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2015-08-31 |
| 1306213509 | Deborah Kimberly Bryk | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2015-08-24 |
| 1568871887 | Vaughn Chesters Jr. | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2014-08-12 |
| 1487061156 | Jamila Lamb | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2014-07-15 |
| 1336561281 | Linda Johnson-mcclendon | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2014-01-13 |
| 1124455217 | Sharita Brown | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2013-10-03 |
| 1396172466 | Shelisa Triplett | Counselor | 1400 E 12 Mile Rd, Madison Heights, MI 48071-2651 | 2013-10-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952918831 | United Medical Laboratory LLC | Clinical Medical Laboratory | 30675 Stephenson Hwy, Suite B, Madison Heights, MI 48071 | 2020-09-25 |
| 1033776372 | Terry Ky-sieu Tran | Student in an Organized Health Care Education/Training Program | 27351 Dequindre Rd., Madison Height, MI 48071 | 2019-05-22 |
| 1942865894 | Jordan Lee Stav | Student in an Organized Health Care Education/Training Program | Sjmo Emergency Medicine Residency Program, 27351 Dequindre Rd, Madison Heights, MI 48071 | 2019-05-07 |
| 1538624960 | Holistic Therapy Institute Physical Therapy, Inc. | Physical Therapist | 30201 Dequidre Rd Suite1, Madison Hts, MI 48071 | 2019-02-11 |
| 1720558216 | Kevin Luce | Physical Therapy Assistant | 1433 E 12 Mile Road, Madison Heights, MI 48071 | 2018-11-28 |
| 1861974297 | Olubunmi Oluremi Aluko | Physical Therapist | 1410 E.14 Mile Road, Madison Heights, MI 48071 | 2018-09-01 |
| 1558859579 | Leslie G Lafer, Dopllc | Obstetrics & Gynecology | 1437 E 12 Mile Road, Building D, Madison Heights, MI 48071 | 2018-04-25 |
| 1588161020 | Daniel Eugene Geer | Physical Therapist | 1410 E 14 Mile Road, Madison Heights, MI 48071 | 2018-04-11 |
| 1881100931 | Medshop Pharmacy LLC | Pharmacy | 30549 Stephenson Hwy Ste B, Madison Heights, MI 48071 | 2017-12-26 |
| 1730602004 | Ali Bazzy | Nurse Practitioner | 27483 Dequindre Suite 304, Madison Hgts, MI 48071 | 2017-07-19 |
| Find all providers in zip 48071 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760984165 | Laura Lan Schefke | Peer Specialist | 1400 E 12 Mile Rd, Madison Heights, MI 48071 | 2018-03-02 |
| 1972012052 | Matthew A Sroufe | Peer Specialist | 28303 Dequindre Rd, Madison Heights, MI 48071-3040 | 2017-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063026284 | Leah Mae Sindone | Peer Specialist | 22324 Derby Rd, Woodhaven, MI 48183-3700 | 2020-09-04 |
| 1992314728 | Willie Earl Feggins | Peer Specialist | 370 Country Club Rd, Holland, MI 49423-8303 | 2020-07-28 |
| 1831711613 | John Lee Williams Jr. | Peer Specialist | 24400 Schoolcraft, Redford, MI 48239-2633 | 2020-05-14 |
| 1568084861 | Zannie Roy Jackson Jr. | Peer Specialist | 36801 Ann Arbor Trl, Livonia, MI 48150-3422 | 2020-05-11 |
| 1417578865 | Veronica R Vasquez | Peer Specialist | 500 Hancock St # 48602, Saginaw, MI 48602-4224 | 2020-04-27 |
| 1235768680 | Matthew Milz | Peer Specialist | 145o S Lapeer Rd, Oxford, MI 48371-4982 | 2020-04-07 |
| 1558996132 | Camille Jewell Jackson | Peer Specialist | 8181 N Wayne Rd Apt S2147, Westland, MI 48185-3842 | 2020-03-04 |
| 1073146908 | James Laroach | Peer Specialist | 913 W. Homes Suite 200, Lansing, MI 48910 | 2020-02-19 |
| 1578193827 | Axel Lee Gruenberg | Peer Specialist | 221790 West 9 Mile, Southfield, MI 48033 | 2020-01-24 |
| 1962032078 | Brianne Salchert | Peer Specialist | 1170 Michigan Rd., Port Huron, MI 48060 | 2020-01-17 |
| Find all providers with the same taxonomy | ||||
| City | MADISON HEIGHTS |
| Zip Code | 48071 |
Please comment or provide details below to improve the information on DAVID KEITH WALLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.