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Individual
DR. GABRIEL ABRAHAM WALLACE
Active
Individual
DR. GABRIEL ABRAHAM WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036142476
IL
2086S0129X
Vascular Surgery Physician
Primary
036142476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036142476
—
IL
Enumeration date
03/29/2012
Last updated
08/31/2023
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