Wallace, Gabriel Abraham

Wallace, Gabriel Abraham is an sole proprietor health care provider with primary practice located at 12251 S 80Th Ave Ste 1520 , Palos Heights IL 60463-1290. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Wallace, Gabriel Abraham can be contacted via phone (708) 923-4200.

Contact Information

Primary practice address
12251 S 80Th Ave Ste 1520 Palos Heights IL 60463-1290
Phone: (708) 923-4200
Fax: (708) 923-4201
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 036142476 Illinois
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 036142476 Illinois

Profile Details

NPI number 1609142074
LBN Legal business name Wallace, Gabriel Abraham
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 29th, 2012
Last updated Aug 31st, 2023 - about 3 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 1609142074 NPPES
Illinois MEDICAID 036142476

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