DAVID WALLACE (NPI# 1609804525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609804525 |
| Entity Type | Individual |
| Full Name | DAVID WALLACE |
| Credential | M.D. |
| Practice Address |
340 W Lincoln St Belleville IL 62220-1900 |
| Practice Telephone | 6182336044 |
| Practice Fax Number | 6182333287 |
| Mailing Telephone | 6182336044 |
| Mailing Fax Number | 6182333287 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2017-04-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
036092919 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 0360929191 | 05 | |
| ESSENCE | 12269 | 01 | |
| HEALTHLINK | 235649 | 01 | |
| GHP | 37099690008 | 01 | |
| MO | 205943608 | 05 | |
| CMR | 54656 | 01 | |
| MERCY | E43629 | 01 | |
| RR MEDICARE | 060046618 | 01 | |
| UHC | 1734162 | 01 | |
| IL | RAILROAD | P01024928 | 01 |
| HEALTH ALLIANCE | 093355 | 01 | |
| MO | BCBS MO | 107076 | 01 |
| WELLCARE | 235649 | 01 | |
| SECURE HORIZONS | 2501200 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700327061 | David Wallace | Student in an Organized Health Care Education/Training Program | 24606 Mosquero Ln, Mission Viejo, CA 92691-4913 | 2017-03-19 |
| 1265743595 | David R Wallace Jr. | Radiology | 200 W Arbor Dr # Mc0834, Department of Radiology, San Diego, CA 92102-0834 | 2010-07-01 |
| 1386868487 | David Stuart Wallace | Chiropractor | 2330 Highway 94 South Outer Rd, Saint Charles, MO 63303-8301 | 2007-04-12 |
| 1649343641 | David Michael Wallace | Chiropractor | 112 W Grand Ave, Rainbow City, AL 35906-3233 | 2006-11-16 |
| 1932193604 | David Wallace | Anesthesiology | 738 Golden Pheasant Dr, Draper, UT 84020-8454 | 2005-09-08 |
| 1386646206 | David Allen Wallace | Dentist | 206 S Walker St, Princeton, WV 24740-2747 | 2005-08-11 |
| 1295736809 | David B. Wallace | Radiology | 325 N Highland Ave, Provena Mercy Medical Center, Aurora, IL 60506-3811 | 2005-08-04 |
| 1679576276 | David Alan Wallace | Ophthalmology | 11600 Wilshire Blvd, Ste 200, Los Angeles, CA 90025-1782 | 2005-05-27 |
| 1619596335 | David Alexander Wallace | Student in an Organized Health Care Education/Training Program | 920 Madison Ave Ste 447, Memphis, TN 38103-3438 | 2020-04-13 |
| 1396364402 | David Carter Wallace | Student in an Organized Health Care Education/Training Program | 620 Shadow Ln, Las Vegas, NV 89106-4119 | 2020-04-09 |
| Street Address |
340 W LINCOLN ST |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62220-1900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477558922 | John A. Hucker | Obstetrics & Gynecology | 340 W Lincoln St, Ste 560, Belleville, IL 62220-1900 | 2005-06-20 |
| 1609313758 | Marianne Guthrie | Nurse Practitioner | 340 W Lincoln St, 200, Belleville, IL 62220-1900 | 2017-01-27 |
| 1841683133 | Kathryn Liermann | Physician Assistant | 340 W Lincoln St, Suite 540, Belleville, IL 62220-1900 | 2015-03-10 |
| 1447686886 | Amelia Gerke | Physician Assistant | 340 W Lincoln St, Suite 540, Belleville, IL 62220-1900 | 2013-09-17 |
| 1811286305 | Sherry Tindall | Nurse Practitioner | 340 W Lincoln St, Suite 400, Belleville, IL 62220-1900 | 2011-04-05 |
| 1427204965 | Elizabeth Renaker-jansen | Plastic Surgery | 340 W Lincoln St, Suite 500, Belleville, IL 62220-1900 | 2008-08-15 |
| 1528214624 | Vidya Shankaran | Plastic Surgery | 340 W Lincoln St, Ste 500, Belleville, IL 62220-1900 | 2008-08-08 |
| 1811188949 | Kristina Naseer | Anesthesiology | 340 W Lincoln St, Suite 200, Belleville, IL 62220-1900 | 2007-08-05 |
| 1154538064 | Desiree Y Miller | Physician Assistant | 340 W Lincoln St, Suite#300, Belleville, IL 62220-1900 | 2007-05-17 |
| 1700962271 | Lincoln Surgical Group | Surgery | 340 W Lincoln St, Suite 500, Belleville, IL 62220-1900 | 2006-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144729716 | St. Elizabeth's Hospital of The Hospital Sisters of The Third Order Of | Clinic/Center | 180 South Third Street Suite 101, Belleville, IL 62220 | 2018-02-08 |
| 1437675535 | Prorehab PC | Occupational Therapist | 1915 Carlyle Ave, Ste D, Belleville, IL 62220 | 2017-08-21 |
| 1629527650 | Arika Forrest | Nurse Practitioner | 140 Iowa Ave, Belleville, IL 62220 | 2016-10-03 |
| 1861861403 | Belleville Endoscopy LLC | Internal Medicine | 311 West Lincoln St, Suite 101, Belleville, IL 62220 | 2015-09-24 |
| 1962871558 | Antony Frierdich | Specialist/Technologist | 22 South 13th Street, Belleville, IL 62220 | 2015-09-24 |
| 1588032858 | Dana Wright | Pharmacist | 211 South Thrid Street, Belleville, IL 62220 | 2015-09-03 |
| 1629208731 | Lisa Marlow Johnson | Developmental Therapist | 34 Fenwood Dr, Belleville, IL 62220 | 2009-07-23 |
| 1841361623 | Neurological Surgery of Belleville | Neurological Surgery | 340 West Lincoln Street, Suite 540, Belleville, IL 62220 | 2006-11-13 |
| 1689769119 | Kathy Jo Corn | Counselor | 521 W. Main, Suite 201 B, Belleville, IL 62220 | 2006-10-03 |
| 1780609578 | Southern Illinois Health Care Foundation, Inc. | Counselor | 180 S 3rd St Ste 103&104, Belleville, IL 62220 | 2006-07-13 |
| Find all providers in zip 62220 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962698597 | Cardiology Center of New Jersy LLC | Internal Medicine | 50 Newark Ave Ste 204, Belleville, NJ 07109-1193 | 2007-09-18 |
| 1467573105 | Core Diagnostics Pa | Internal Medicine | 1 Franklin Ave, Belleville, NJ 07109 | 2007-04-02 |
| 1205953767 | Muhlenberg Heart Group | Internal Medicine | 338 Cortlandt St, Belleville, NJ 07109-3202 | 2007-03-22 |
| 1609962992 | Bulent Dincer | Internal Medicine | 517 E Waters Edge Dr, Belleville, IL 62221-7813 | 2006-10-05 |
| 1568480374 | John J Lehman Jr. | Internal Medicine | 4600 Memorial Dr Ste W3, Belleville, IL 62226-5359 | 2006-07-18 |
| 1891729497 | Metro Cardiology Group Ltd | Internal Medicine | 4600 Memorial Dr Ste 420, Belleville, IL 62226-5366 | 2006-07-10 |
| 1184602096 | Mohammad Mithal Vakassi | Internal Medicine | 4600 Memorial Dr Ste W1, Belleville, IL 62226-5359 | 2006-01-03 |
| 1063411957 | Mario A Criscito | Internal Medicine | 50 Newark Ave, Suite 204, Belleville, NJ 07109-1185 | 2005-07-21 |
| 1962054551 | Vanessa Ahearn | Internal Medicine | 5 Franklin Ave Ste 302, Belleville, NJ 07109-3522 | 2019-07-12 |
| 1629333711 | Keshav M Shiva Md Pa | Internal Medicine | 140 Belmont Ave, 102, Belleville, NJ 07109-1017 | 2012-07-05 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62220 |
Please comment or provide details below to improve the information on DAVID WALLACE.
| 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.