Individual
MICHAEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
607 ELLIOTT AVE, CINCINNATI, OH 45215-5417
(513) 227-9840
Mailing address
607 ELLIOTT AVE, CINCINNATI, OH 45215-5417
(513) 227-9840
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
03/15/2022
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