Individual
DR. GABRIEL ABRAHAM WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12251 S 80TH AVE STE 1520, PALOS HEIGHTS, IL 60463-1290
(708) 923-4200
(708) 923-4201
Mailing address
PO BOX 84992, CHICAGO, IL 60689-4992
(918) 710-3710
(918) 770-0058
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036142476
IL
2086S0129X
Vascular Surgery Physician
Primary
036142476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036142476
—
IL
Enumeration date
03/29/2012
Last updated
08/31/2023
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