Individual
DR. NICHOLAS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3016 BARCLAY WAY, ANN ARBOR, MI 48105-9464
(616) 309-3319
Mailing address
3016 BARCLAY WAY, ANN ARBOR, MI 48105-9464
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
4301110098
MI
207X00000X
Orthopaedic Surgery Physician
Primary
75714
WI
Other
Enumeration date
06/08/2016
Last updated
10/19/2022
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