KIMBERLY WALLACE MD PC (NPI# 1497397202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497397202 |
Entity Type | Organization |
Organization Name | KIMBERLY WALLACE MD PC |
Practice Address |
12900 W 9 Mile Road Oak Park MI 48237 |
Mailing Address |
P.o. Box 700263 Plymouth MI 48170 |
Practice Telephone | 2485479292 |
Enumeration Date | 2019-10-14 |
Last Update Date | 2019-11-13 |
Authorized Official Name | KIMBERLY WALLACE (PRESIDENT) |
Authorized Official Telephone | 2485479292 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
Street Address |
12900 W 9 MILE ROAD |
City | OAK PARK |
State | MI |
Zip Code | 48237 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699395459 | Kroger Co of Michigan | Durable Medical Equipment & Medical Supplies | 25940 Greenfield Rd, Oak Park, MI 48237 | 2020-04-22 |
1174009211 | Jo-anne Spencer Woodard | Social Worker | 23300 Greenfield, Suite 122, Oak Park, MI 48237 | 2018-07-12 |
1285163600 | Yolanda Alicia Winters-byrdo | Social Worker | 18712 Quarry Rd., Riverview, MI 48237 | 2017-06-08 |
1972059699 | Cynthia F Lewis | Technician, Other | 15251 Kenwood St., Oak Park, MI 48237 | 2016-09-01 |
1083039531 | Tema Pefok | Home Health Aide | 21930 Harding St, Oak Park, MI 48237 | 2014-02-20 |
1073937116 | A1 Home Help Services | Home Health | 21700 Green Field Road, 253, Oak Park, MI 48237 | 2014-02-10 |
1629346648 | Mitun Chablani | Physical Therapist | 25900 Greenfield Rd Ste 110, Oak Park, MI 48237 | 2011-12-05 |
1841575891 | Hazy Mindful Care Giving Agency Inc | Hospice Care, Community Based | 21700 Greenfield, Ste 264, Oakpark, MI 48237 | 2011-10-20 |
1710101688 | Andrew Hardy Jr. | Internal Medicine | 22100 Greenfield Road, Oak Park, MI 48237 | 2007-04-12 |
1699801746 | Rachel N Freedland | Social Worker | 26000 Stratford Pl, Oak Park, MI 48237 | 2007-02-25 |
Find all providers in zip 48237 |
Taxonomy Code | 261QM2500X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Medical Specialty |
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
Notes: [7/1/2003: new] |
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1558579243 | Affiliates In Diseases & Surgery of The Skin, S.c. | Clinic/Center | 1050 Chicago Avenue, Oak Park, IL 60302 | 2007-05-18 |
1669731592 | Artemis, LLC | Clinic/Center | 137 N Oak Park Ave, Suite 129, Oak Park, IL 60301-1344 | 2012-05-12 |
1417148685 | Rejuvenetics, Ltd | Clinic/Center | 137 N Oak Park Ave, Ste 208, Oak Park, IL 60301-1344 | 2007-08-05 |
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1023662079 | J & D Vision Inc | Clinic/Center | 41821 Garfield Rd, Clinton Twp, MI 48038-1965 | 2019-07-29 |
1649839945 | Michigan Institute of Sleep Disorders Pllc | Clinic/Center | 7108 Autumn Hill Dr, West Bloomfield, MI 48323-3904 | 2019-06-10 |
1447715131 | Ryan Klanseck, Do | Clinic/Center | 16986 Robbins Rd Ste 140, Grand Haven, MI 49417-2795 | 2019-02-06 |
1598242455 | Gratiot Advanced Center LLC | Clinic/Center | 7612 Gratiot Ave Ste 200, Detroit, MI 48213-2822 | 2018-07-24 |
1902356140 | Midmichigan Pain | Clinic/Center | 2305 Hawthorn Dr, Suite B, Mt Pleasant, MI 48858-1202 | 2016-10-12 |
1184085516 | Hester S Pernell Md Pllc | Clinic/Center | 24628 Ridgeview Dr, Farmington Hills, MI 48336-1905 | 2016-03-12 |
1275937625 | Innovative Anesthesia Services PC | Clinic/Center | 847 Parchment Dr Se Ste 105, Grand Rapids, MI 49546 | 2014-10-14 |
1538569439 | Maple Healthcare Medical Center P.C. | Clinic/Center | 2442 E Maple Ave Ste 400, Flint, MI 48507-4462 | 2014-08-27 |
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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.