Individual
DAVID MICHAEL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8001 CHALLIS RD, BRIGHTON, MI 48116-7446
(810) 227-9510
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301096113
MI
208000000X
Pediatrics Physician
4301096113
MI
Other
Enumeration date
05/18/2010
Last updated
04/17/2019
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