# KIMBERLY WALLACE MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497397202
- **Authorized official:** KIMBERLY WALLACE MD (PRESIDENT)
- **Authorized official phone:** (248) 547-9292

## Contact information

- **Practice address:** 12900 W 9 MILE ROAD, OAK PARK, MI 48237
- **Practice address phone:** (248) 547-9292
- **Mailing address:** P.O. BOX 700263, PLYMOUTH, MI 48170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 10/14/2019
- **Last updated:** 11/13/2019