Individual
CARMEL WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
138 LEADER AVE, OFFICE 241, UNIVERSITY OF KENTUCKY, DEPARTMENT OF PEDIATRICS, LEXINGTON, KY 40506-9983
(859) 323-1432
(859) 323-3499
Mailing address
138 LEADER AVE, OFFICE 241, UNIVERSITY OF KENTUCKY, DEPARTMENT OF PEDIATRICS, LEXINGTON, KY 40506-9983
(859) 323-1432
(859) 323-3499
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18479
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64184799
—
KY
Enumeration date
07/06/2005
Last updated
12/18/2015
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