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Individual

DIANE ELIZABETH WALLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
13905 GRISHAM DR, CARMEL, IN 46033-0026
(630) 310-2118
Mailing address
13905 GRISHAM DR, CARMEL, IN 46033-0026
(630) 268-1102

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01091007A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
036061857
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036061857
IL
01
060043700
RAILROAD MEDICARE
Enumeration date
05/17/2006
Last updated
02/09/2026
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