DR. GABRIEL ABRAHAM WALLACE (NPI# 1609142074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609142074 |
| Entity Type | Individual |
| Full Name | DR. GABRIEL ABRAHAM WALLACE |
| Credential | MD |
| Practice Address |
10258 Southwest Hwy Ste A Chicago Ridge IL 60415-1361 |
| Mailing Address |
Po Box 84992 Chicago IL 60689-4992 |
| Practice Telephone | 7083469533 |
| Practice Fax Number | 7084994312 |
| Mailing Telephone | 9187103710 |
| Mailing Fax Number | 9187700058 |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2020-02-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 036142476 | IL | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
036142476 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036142476 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1959 Ne Pacific St, Seattle, WA 981956410 | 2065433687 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932571056 | Gabriel Wayne Wallace | Technician | 5208 Michiban Ave., Prescott, MI 48756 | 2015-10-28 |
| Street Address |
10258 SOUTHWEST HWY STE A |
| City | CHICAGO RIDGE |
| State | IL |
| Zip Code | 60415-1361 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386644037 | Dean Michael Govostis | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2005-07-22 |
| 1538791793 | Vascular Surgery Associates, Pllc | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2020-02-06 |
| 1326689696 | Lindsay Frances Maas | Physician Assistant | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2019-10-08 |
| 1326544404 | Regina Tsang | Nurse Practitioner | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2018-04-05 |
| 1326274556 | Mohammad Sarhan | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2009-06-02 |
| 1184624819 | Martin Ira Ellenby | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396233854 | All American Physical Therapy P.C. | Clinic/Center | 9830 Ridgeland Ave Ste 3a, Chicago Ridge, IL 60415 | 2018-04-30 |
| 1841711561 | Limitless Transportation of Illinois | Non-emergency Medical Transport (VAN) | 6726 107th St Unit 2c, Chicago Ridge, IL 60415 | 2017-07-03 |
| 1376927293 | Fariha Querishi | Dentist | 6501 W 95th Street, Chicago Ridge, IL 60415 | 2015-07-10 |
| 1780958603 | Delores Jean Jackson | Occupational Therapy Assistant | 10300 Southwest Highway, Chicago Ridge, IL 60415 | 2012-02-24 |
| 1376855395 | Aa1 Medicar Transpotation Inc | Non-emergency Medical Transport (VAN) | 10624 S Major St 2n, Chicago Ridge, IL 60415 | 2010-07-07 |
| 1952591448 | Orion Diagnostic & Chiropractic Center | Chiropractor | 9830 S. Ridgeland Ave, Suite # 5, Chicago Ridge, IL 60415 | 2007-07-31 |
| 1518006808 | Christopher John Green | Dentist | 6422 W 107th St, Chicago Ridge, IL 60415 | 2007-02-05 |
| 1376697383 | Luxottica Retail North America, Inc | Eyewear Supplier (Equipment, not the service) | 320 Chicago Ridge Mall # C15, Chicago Ridge, IL 60415 | 2007-01-23 |
| 1144372194 | Ikechukwu Oguejiofor | Urology | 10400 S0uthwest Highway, Chicago Ridge, IL 60415 | 2007-01-18 |
| 1306909148 | Edward Philip Mann | Ophthalmology | 5850 W 111th St, Chicago Ridge, IL 60415 | 2006-12-19 |
| Find all providers in zip 60415 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386644037 | Dean Michael Govostis | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2005-07-22 |
| 1538791793 | Vascular Surgery Associates, Pllc | Surgery | 10258 Southwest Hwy Ste A, Chicago Ridge, IL 60415-1361 | 2020-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267324 | Congress Vascular Center LLC | Surgery | 41 W Congress Pkwy Fl 1, Chicago, IL 60605-1531 | 2017-07-11 |
| 1043731300 | Elmwood Park Vascular Center LLC | Surgery | 7230 W North Ave Ste 108, Elmwood Park, IL 60707-4261 | 2017-06-27 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1992126668 | Vascular Specialists LLC | Surgery | 20060 Governors Dr Ste 102, Olympia Fields, IL 60461-1099 | 2013-12-26 |
| 1588959548 | Patrick Michael Sullivan Neville | Surgery | 4600 Memorial Dr Ste 120, Belleville, IL 62226-5359 | 2011-06-17 |
| 1235454968 | Margaret Claire Rigamer | Surgery | 1901 W Harrison St Dept Of, Chicago, IL 60612-3714 | 2010-04-06 |
| 1215251541 | John V. White, Md, LLC | Surgery | 8816 W Dempster St, Niles, IL 60714-5109 | 2010-03-15 |
| 1710212733 | Vascular Surgery and Interpretation S.c. | Surgery | 3330 W 177th St Ste 2c1, Hazel Crest, IL 60429-2184 | 2009-10-08 |
| 1538391792 | Usa Vein Clinics of Chicago LLC | Surgery | 4141 Dundee Rd, Northbrook, IL 60062-2129 | 2009-08-20 |
| 1306010731 | Tanq, Inc. | Surgery | 18510 S Marilynn Ct, Mokena, IL 60448-9517 | 2008-04-16 |
| Find all providers with the same taxonomy | ||||
| City | CHICAGO RIDGE |
| Zip Code | 60415 |
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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.