Individual
DR. DANYALE A WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1901 W POLK STREET, FLOOR 10, CHICAGO, IL 60612
(312) 964-0060
Mailing address
300 W NORTH AVE, APT. 302, CHICAGO, IL 60610-1248
(312) 274-9694
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
336076552
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217008
MEDICARE GROUP #
—
Enumeration date
04/03/2007
Last updated
10/29/2008
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