Beth Ilene Wallace
Internist Rheumatology
1500 E Medical Center Dr
Ann Arbor
, Michigan 48109-5000
Beth Ilene Wallace
Internist Rheumatology
1500 E Medical Center Dr
Ann Arbor
, Michigan 48109-5000
(734) 647-5299
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About
Features
Specialties
- Internist
- Rheumatology
Languages spoken
- English
Location
First Address
- Beth Ilene Wallace
- 3621 S State St
- Ann Arbor, MI
- Zip : 48108-1633
- Phone : (734) 647-5299
Second Address
- Beth Ilene Wallace
- 1500 E Medical Center Dr
- Ann Arbor, MI
- Zip : 48109-5000
- Phone : (734) 936-4000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207R00000X | Internist | 4301096126 | MI |
| N | 111NI0900X | Internist | 4301096126 | MI |
| Y | 207RR0500X | Rheumatology | 4301096126 | MI |
National Provider Identifier
| NPI | 1023336948 |
|---|---|
| Provider Name | Beth Ilene Wallace |
| First Address | Ann Arbor, MI 48108-1633 |
| Second Address | Ann Arbor, MI 48109-5000 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/05/2010 |
| Last Update Date | 01/05/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.