Individual
DIANE E WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1355 MARINERS DR, WARSAW, IN 46582-7145
(574) 372-0000
Mailing address
608 UNION CHAPEL RD, FORT WAYNE, IN 46845-9357
(260) 498-2020
(260) 498-2030
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01061919A
IN
Other
Enumeration date
06/06/2006
Last updated
03/10/2022
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