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NPI Profile for TRACY WALLACE in DETROIT, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Administrator |
163WA2000X |
| NPI Number | 1326481755 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 04/16/2013 | |
| Last updated | 04/16/2013 - About 13 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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TRACY WALLACE
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TRACY WALLACE