Organization
KIMBERLY WALLACE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY WALLACE MD (PRESIDENT)
(248) 547-9292
Entity
Organization
Contact information
Practice address
12900 W 9 MILE ROAD, OAK PARK, MI 48237
(248) 547-9292
Mailing address
P.O. BOX 700263, PLYMOUTH, MI 48170
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/14/2019
Last updated
11/13/2019
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