Wallace, Danyale A

Wallace, Danyale A is an sole proprietor health care provider with primary practice located at 1901 W Polk Street Floor 10, Chicago IL 60612. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Wallace, Danyale A can be contacted via phone (312) 964-0060.

Contact Information

Primary practice address
1901 W Polk Street Floor 10 Chicago IL 60612
Phone: (312) 964-0060
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 336076552 Illinois

Profile Details

NPI number 1992826358
LBN Legal business name Wallace, Danyale A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 3rd, 2007
Last updated Oct 29th, 2008 - about 18 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 1992826358 NPPES
Other 217008 MEDICARE GROUP #

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