Individual
SARAH J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 975-1845
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
5315052367
MI
207P00000X
Emergency Medicine Physician
Primary
5101018343
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144458969
—
MI
Enumeration date
07/01/2009
Last updated
02/24/2025
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