Individual
CARLY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5333 MCAULEY DR STE R-5003, YPSILANTI, MI 48197-1014
(734) 712-3376
(734) 887-8943
Mailing address
5333 MCAULEY DR STE R-5003, YPSILANTI, MI 48197-1014
(734) 712-3376
(734) 887-8943
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
15182
GA
Other
Enumeration date
06/26/2023
Last updated
09/15/2025
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