DR. KEVIN R WALLACE (NPI# 1053423285) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053423285 |
| Entity Type | Individual |
| Full Name | DR. KEVIN R WALLACE |
| Credential | DMD |
| Practice Address |
150 E Huron St Ste 1103 Chicago IL 60611 |
| Mailing Address |
7501 Lemont Rd Ste 300 Woodridge IL 60517-2653 |
| Practice Telephone | 3126769893 |
| Practice Fax Number | 8157447059 |
| Mailing Telephone | 6303245370 |
| Mailing Fax Number | 8157447059 |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2018-07-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 019-022339 | IL | Dental Providers |
| Y | 122300000X | Dentist | 019022339 | IL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | PRACTICE LOCATION TYPE II NPI | 1205145554 | 01 |
| IL | PRACTICE LOCATION TYPE II NPI | 1508198474 | 01 |
| IL | GROUP TYPE II NPI | 1063649770 | 01 |
| IL | PRACTICE LOCATION TYPE II NPI | 1295165439 | 01 |
| IL | PRACTICE LOCATION TYPE II NPI | 1306177241 | 01 |
| IL | PRACTICE LOCATION TYPE II NPI | 1760882005 | 01 |
| IL | GROUP TYPE II NPI | 1053431981 | 01 |
| IL | DENTAL-IL | 019-022339 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659760700 | Kevin Wallace | Naturopath | 1700 N Tully Rd Apt G221, Turlock, CA 95380-6879 | 2015-01-13 |
| 1144576919 | Kevin Gary Wallace | Pharmacist | 94 Ladd Ave, Staten Island, NY 10312-1515 | 2012-07-31 |
| 1972750909 | Kevin D Wallace | Dentist | 1200 E Woodhurst Dr Ste A200, Springfield, MO 65804-3745 | 2008-08-21 |
| 1316960131 | Kevin Bruce Wallace | Dentist | 949 N 14th St, Leesburg, FL 34748-3838 | 2006-07-25 |
| 1033619614 | Kevin R Wallace | Case Manager/Care Coordinator | 3620 Stutz Dr, Canfield, OH 44406-9176 | 2018-02-20 |
| 1518391135 | Kevin Wallace | Massage Therapist | 817 Coffee Rd Ste D, Modesto, CA 95355-4241 | 2013-08-30 |
| 1225388457 | Kevin Wallace | Student in an Organized Health Care Education/Training Program | 30 Warren St, Boston, MA 02135-3602 | 2012-09-14 |
| 1730128372 | Kevin L Wallace | Preventive Medicine | 925 E Mcdowell Rd, Phoenix, AZ 85006-2502 | 2006-06-06 |
| 1255309258 | Kevin Ps Wallace | Internal Medicine | 1300 Crane St, Menlo Park, CA 94025-4260 | 2006-03-08 |
| 1033195631 | Kevin H Wallace | Internal Medicine | 1350 Hickory St, Melbourne, FL 32901-3224 | 2005-12-16 |
| Street Address |
150 E HURON ST STE 1103 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538168695 | Lee Scott Schwartz | Psychiatry & Neurology | 150 E Huron St, Suite 1101, Chicago, IL 60611-2999 | 2005-07-20 |
| 1386287621 | Holly Beth Zabrin | Dietitian, Registered | 150 E Huron St, Chicago, IL 60611-2999 | 2019-10-18 |
| 1760031249 | Alexandra Sandoval | Social Worker | 150 E Huron St, Chicago, IL 60611-2999 | 2019-09-08 |
| 1881180636 | Select Physical Therapy Orthopedic Services, Inc. | Clinic/Center | 150 E Huron St, Chicago, IL 60611-2999 | 2018-07-05 |
| 1558871483 | Sandra Buecker Spears | Social Worker | 150 E Huron St, Chicago, IL 60611-2999 | 2017-10-05 |
| 1760918296 | Eating Recovery Center | Social Worker | 150 E Huron St, Suite 1300, Chicago, IL 60611-2999 | 2017-05-03 |
| 1861926099 | Abigail Damsky Brown | Psychologist | 150 E Huron St, Chicago, IL 60611-2999 | 2017-04-13 |
| 1366989329 | Brittany Statler | Social Worker | 150 E Huron St, Suite 1300, Chicago, IL 60611-2999 | 2017-01-27 |
| 1659814192 | Eating Recovery Center | Community Based Residential Treatment Facility, Mental Illness | 150 E Huron St, Suite 1200, Chicago, IL 60611-2999 | 2016-12-01 |
| 1891238119 | Sarita Aguirre | Dietitian, Registered | 150 E Huron St, 12th Floor, Chicago, IL 60611-2999 | 2016-11-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861092835 | Lauren Less | Social Worker | 111 East Pearson St, Chicago, IL 60611 | 2020-10-29 |
| 1134735962 | Kalvin Cheuk Hang Lung | Student in an Organized Health Care Education/Training Program | 675 N St Clair St 17th Floor, Chicago, IL 60611 | 2020-09-17 |
| 1487267845 | Ashley Marie Sablich | Student in an Organized Health Care Education/Training Program | 250 E Huron Street, Suite 1-200, Chicago, IL 60611 | 2020-08-26 |
| 1245854033 | Danielle Humphrey | Student in an Organized Health Care Education/Training Program | Pa Program, Suite 1-200, 240 East Huron Street, Chicago, IL 60611 | 2020-06-08 |
| 1801418074 | Sana Healing Collective | Clinic/Center | 405 N. Wabash Street, Chicago, IL 60611 | 2020-05-11 |
| 1194359489 | Insight:eating Disorders, Weight Management & Psychological Centers | Psychiatric Hospital | 1 E. Erie Street, 4th Floor, Chicago, IL 60611 | 2020-02-26 |
| 1902439193 | Iwona Boska | Nurse Practitioner | 676 N St.clair Street, Suite 2140, Chicago, IL 60611 | 2020-02-17 |
| 1922643576 | Sarah Elizabeth Schwartzer | Audiologist | Chicago Dizziness and Hearing, 645 North Michigan Avenue, Suite 410, Chicago, IL 60611 | 2019-11-07 |
| 1023668852 | Anne Marguerite Davidson | Student in an Organized Health Care Education/Training Program | Mcgraw Medical Center, 240 E Huron Street, Suite 1-200, Chicago, IL 60611 | 2019-09-13 |
| 1871141085 | Coast Management | Durable Medical Equipment & Medical Supplies | 40 E. Chicago Ave, Suite 149, Chicago, IL 60611 | 2019-08-30 |
| Find all providers in zip 60611 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293801 | Wh Il Dental Pllc | Dentist | 18086 N. Kilpatrick Ave., Chicago, IL 60639 | 2020-10-21 |
| 1710598271 | Amandeep Kaur Brar | Dentist | 1255 S Michigan Ave Apt 3704, Chicago, IL 60605-3324 | 2020-08-10 |
| 1770193971 | Alex Sarpong | Dentist | 801 S Paulina St Rm 361, Chicago, IL 60612-7210 | 2020-08-03 |
| 1285243675 | Alicia Marie Karczewski | Dentist | 845 N Michigan Ave Ste 922e, Chicago, IL 60611-2194 | 2020-07-30 |
| 1740898154 | Zeeshan Anjum | Dentist | 2322 S Canal St Unit 402, Chicago, IL 60616-2021 | 2020-07-22 |
| 1619594835 | Rizina Hakimiyan | Dentist | 4849 N Milwaukee Ave Ste 403, Chicago, IL 60630-2169 | 2020-07-03 |
| 1235756735 | Payal K Shah | Dentist | 330 N Jefferson St Apt 1906, Chicago, IL 60661-1322 | 2020-06-30 |
| 1124643028 | Ashley Swan | Dentist | 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 | 2020-06-16 |
| 1023633054 | Jennifer Kirk Munaretto | Dentist | 1224 W Van Buren St Apt 801, Chicago, IL 60607-3367 | 2020-06-16 |
| 1669097614 | Seon Gyeong Park | Dentist | 1150 W 15th St Unit 236, Chicago, IL 60608-3688 | 2020-06-15 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.