Individual
DR. DANIEL LELAND WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
275 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2531
(616) 267-0800
(616) 267-0801
Mailing address
100 MICHIGAN ST NE # MC-845, GRAND RAPIDS, MI 49503-2560
(616) 267-0800
(616) 267-0801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101011648
MI
Other
Enumeration date
08/19/2005
Last updated
01/22/2025
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