AMY WALLACE (NPI# 1134619463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134619463 |
| Entity Type | Individual |
| Full Name | AMY WALLACE |
| Credential | DO |
| Practice Address |
28050 Grand River Ave Farmington Hills MI 48336-5919 |
| Mailing Address |
1488 Schooner Cv Highland MI 48356-2259 |
| Practice Telephone | 2484718822 |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2019-01-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 1134619463 | MI | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922472455 | Amy Wallace | Nurse Practitioner | 333 Portage St, Kalamazoo, MI 49007-4931 | 2015-11-20 |
| 1760887657 | Amy Wallace | Case Manager/Care Coordinator | 34 Seals Dr, Monroe, NY 10950-3949 | 2014-11-04 |
| 1376958553 | Amy Wallace | Occupational Therapy Assistant | 741 Fenwick Rd, Hillsboro, OH 45133-6789 | 2014-06-25 |
| 1528362902 | Amy Vosburg Wallace | Counselor | 6814 Auburn Oak Trl, Humble, TX 77346-1366 | 2010-12-29 |
| 1861663122 | Amy Beth Wallace | Licensed Practical Nurse | 150 Gate House Trl, Henrietta, NY 14467-9559 | 2008-03-14 |
| 1831289917 | Amy Piatt Wallace | Speech-Language Pathologist | 238 Cureton St, Greenville, SC 29605-1031 | 2006-10-13 |
| 1104178052 | Amy M Wallace | Nurse Practitioner | 800 Rose St, 4th Floor, Lexington, KY 40536-0001 | 2012-10-02 |
| 1043452063 | Amy Evelyn Wallace | Registered Nurse | 516 Nizhoni Blvd, Gallup, NM 87301-5748 | 2009-04-06 |
| 1740457209 | Amy Wallace | Obstetrics & Gynecology | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2008-05-14 |
| 1376695627 | Amy Catherine Wallace | Occupational Therapist | 2920 Ronald Reagan Blvd, Ste 110, Cumming, GA 30041 | 2007-01-17 |
| Street Address |
28050 GRAND RIVER AVE |
| City | FARMINGTON HILLS |
| State | MI |
| Zip Code | 48336-5919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003811662 | Jyothsna Yalavarthi | Internal Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2005-06-20 |
| 1649895848 | Tehreem Sajjad | Podiatrist | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-06-12 |
| 1700401064 | Anthony Ibrahim | Pharmacy | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-06-12 |
| 1700401155 | Darlene Pham | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-06-11 |
| 1497370050 | Lawrence Jajou | Orthopaedic Surgery | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-06-10 |
| 1548885072 | Ricardo Hernandez | Orthopaedic Surgery | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-06-10 |
| 1669096335 | Krystle Gish | Family Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-29 |
| 1588288278 | Jordan Matthew Correll | Family Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-29 |
| 1053934760 | Brandon Baroff | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-28 |
| 1912520651 | Aaron W Hess | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932733375 | Compassionate Attendant Care Inc | Home Health | 21100 Osmus Street, Suite E, Farmington Hills, MI 48336 | 2020-02-25 |
| 1578123790 | Jon Boynton | Audiologist-Hearing Aid Fitter | 25882 Orchard Lake Rd, Suite 103, Farmington Hills, MI 48336 | 2019-06-19 |
| 1083270078 | Bethesda Home Health LLC | Home Health | 34445 Northwestern Hwy, Farmington Hills, MI 48336 | 2019-05-15 |
| 1174005227 | Cisseri Health Care | Home Health | 28931 W 11 Mile Rd, Farmington Hills, MI 48336 | 2018-09-05 |
| 1326531294 | April A Jackson | Psychologist | 24211 Farmington Road, Farmington Hills, MI 48336 | 2018-06-14 |
| 1083136642 | Nicole Renee Cannonier | Social Worker | 25311 Lynford, Farmington Hills, MI 48336 | 2017-07-14 |
| 1174052021 | Sharon Suzanne King | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 21600 Tulane, Farmington Hills, MI 48336 | 2017-06-05 |
| 1639578909 | Alyssa Kaitlyn Brecht | Rehabilitation Counselor | 23062 Middlebelt Rd, Apt 103, Farmington Hills, MI 48336 | 2014-08-22 |
| 1184038341 | Therapeutic Advantage LLC | Occupational Therapist | 30903 W 10 Mile Rd Ste B, Farmington Hills, MI 48336 | 2014-06-16 |
| 1952727257 | Takara Orum | Social Worker | 21399 Tulane Ave, Apt. 301, Farmington Hills, MI 48336 | 2014-03-11 |
| Find all providers in zip 48336 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679008460 | Laurene Elizabeth Reed | Emergency Medicine | 28050 Grand River Ave Ofc, Farmington Hills, MI 48336-5919 | 2017-04-29 |
| 1225489784 | Marc Peter Goulet | Emergency Medicine | 37000 Grand River Ave Ste 310, Farmington Hills, MI 48335 | 2016-06-27 |
| 1457799041 | Kent C Kim | Emergency Medicine | 29888 Kenloch Dr, Farmington Hills, MI 48331-1920 | 2013-06-05 |
| 1700401155 | Darlene Pham | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-06-11 |
| 1053934760 | Brandon Baroff | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-28 |
| 1912520651 | Aaron W Hess | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-27 |
| 1245853084 | Corban Eugene Caldwell | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-27 |
| 1114540929 | Joshua Martin Smith | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-27 |
| 1700409570 | Caitlin Harrison Kelly | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2020-05-27 |
| 1528626678 | Lucas Beven | Emergency Medicine | 28050 Grand River Ave, Farmington Hills, MI 48336-5919 | 2019-06-04 |
| Find all providers in FARMINGTON HILLS | ||||
| City | FARMINGTON HILLS |
| Zip Code | 48336 |
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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.