Individual
DR. ADAM N WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-5000
Mailing address
2301 N LAKE DR STE 1104, MILWAUKEE, WI 53211-4508
(414) 585-3223
(414) 585-3229
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036.148822
IL
2084N0400X
Neurology Physician
70505
WI
2084N0400X
Neurology Physician
70505-20
WI
2085N0700X
Neuroradiology Physician
Primary
036.148822
IL
2085N0700X
Neuroradiology Physician
61898
MN
2085N0700X
Neuroradiology Physician
70505-20
WI
2085R0202X
Diagnostic Radiology Physician
036.148822
IL
2085R0202X
Diagnostic Radiology Physician
2015013114
MO
2085R0202X
Diagnostic Radiology Physician
319983
NY
2085R0202X
Diagnostic Radiology Physician
70505-20
WI
2085R0202X
Diagnostic Radiology Physician
DR.0068906
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200021565
—
MO
Enumeration date
06/17/2010
Last updated
04/22/2026
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