Individual
JAMES M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
235 E STATE ST, SAINT CROIX FALLS, WI 54024-4117
(715) 483-3221
(715) 483-0507
Mailing address
235 E STATE ST, SAINT CROIX FALLS, WI 54024-4117
(715) 483-3221
(715) 483-0507
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37316
WI
208000000X
Pediatrics Physician
37316
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0413704
MEDICA
—
01
—
110168453
RAILROAD
—
01
—
27G52WA
BLUE CROSS MN FACILITY
MN
05
—
32379700
—
WI
01
—
64Q42WA
BLUE CROSS MN PRO FEE
MN
05
—
948017000
—
MN
01
—
HP27845
HEALTHPARTNERS
—
01
—
NA9031017009
PREFERREDONE
—
Enumeration date
09/02/2006
Last updated
02/02/2021
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