Kevin H Wallace MD

NPI 1033195631 - Internal Medicine - 207RP1001X

NPI Details
NPI 1033195631
Gender Male
Enumeration Date 12/16/2005
Last Updated 02/04/2016
Entity Type Individual
Active Over 11 years ago
Practice Location
8725 N WICKHAM RD
SUITE 302
MELBOURNE FL, 32940-2240, US
Phone (321) 434-9230
Fax (321) 434-9231
Business Location
1223 GATEWAY DR
MELBOURNE FL, 32901-2607, US
Phone (321) 725-4500
Fax (321) 951-7408
Toxanomy
Taxonomy Code 207RP1001X
License State Florida
License Number ME81186
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According to our database, Dr. Kevin H Wallace MD NPI is 1033195631, taxonomy code is 207RP1001X and license number is ME81186, license state is located at Florida. Kevin H Wallace MD physically located at 8725 N Wickham Rd, Melbourne FL, 32940-2240. NPI Number Kevin H Wallace MD has the Individual type.

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1033195631 NPI number is provided on an as is basis without warranty of any kind. 1033195631 is maintained by the National Plan & Provider Enumeration System. The contents of Kevin H Wallace MD are for informational purposes only.