Individual
DR. WALLACE EMANUEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
273 LEEWARD CT, DETROIT, MI 48207-5053
(313) 393-2741
Mailing address
273 LEEWARD CT, DETROIT, MI 48207-5053
(313) 393-2741
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301027092
MI
Other
Enumeration date
03/26/2008
Last updated
04/28/2008
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