Individual
DAVID KEITH WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 E 12 MILE RD, MADISON HEIGHTS, MI 48071-2651
(248) 658-1116
(248) 658-1120
Mailing address
1400 E 12 MILE RD, MADISON HEIGHTS, MI 48071-2651
(248) 658-1116
(248) 658-1120
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MI
Other
Enumeration date
02/14/2019
Last updated
02/14/2019
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