Individual
GREGORY S WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1986 MALL PL, BENTON HARBOR, MI 49022-2332
(269) 945-5854
(369) 945-5854
Mailing address
1860 PAYSHERE CIRCLE, CHICAGO, IL 60674-4035
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036134280
IL
207QB0002X
Obesity Medicine (Family Medicine) Physician
036134280
IL
Other
Enumeration date
06/16/2011
Last updated
01/26/2024
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