Individual
AMY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
28050 GRAND RIVER AVE, FARMINGTON HILLS, MI 48336-5919
(248) 471-8822
Mailing address
660 MILFORD FARMS CT, MILFORD, MI 48381-3351
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1134619463
MI
207P00000X
Emergency Medicine Physician
Primary
5101026825
MI
Other
Enumeration date
05/11/2018
Last updated
06/30/2022
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