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Individual

KIMBERLY WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(248) 661-6425
(248) 325-0094
Mailing address
303 KENDRY, BLOOMFIELD HILLS, MI 48302-0442
(248) 661-6425
(248) 325-0094

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036173865
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
4301084456
MI

Other

Enumeration date
06/22/2006
Last updated
09/30/2025
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