Search › Michigan › 3747P1801X
Gabriel Wallace
NPI 1932571056 · on the registry since 2015 · sole proprietor
Practice
- Address
- 5208 Michiban Ave.
Prescott, MI 48756 - Phone
- (989) 305-9629
- Fax
- (989) 873-1225
Registry record
- Primary taxonomy
- 3747P1801X
3747P1801X
- Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2015-10-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan