Individual
TIMOTHY M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-3741
(262) 434-3702
Mailing address
8901 W LINCOLN AVE, WEST ALLIS, WI 53227-2409
(414) 328-7950
(414) 328-8505
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
41030
WI
Other
Enumeration date
07/12/2006
Last updated
12/30/2021
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