Individual
DAVID A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7330
(216) 844-3781
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
(216) 383-6616
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34-005216
OH
207LA0401X
Addiction Medicine (Anesthesiology) Physician
34-005216
OH
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
34-005216
OH
207LH0002X
Hospice and Palliative Medicine (Anesthesiology) Physician
34-005216
OH
207LP2900X
Pain Medicine (Anesthesiology) Physician
34-005216
OH
207LP3000X
Pediatric Anesthesiology Physician
34-005216
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221259
UNISON
OH
01
—
000000516017
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
0856622
—
OH
01
—
364105
WELLCARE MEDICAID
OH
01
—
50060854
RAILROAD MEDICARE
OH
01
—
5792078
AETNA
OH
01
—
751023
BUCKEYE MEDICAID
OH
01
—
P00412647
MEDICARE RAILROAD
OH
Enumeration date
07/26/2006
Last updated
08/19/2010
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