DR. ADAM DONALD WALLACE (NPI# 1386969079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386969079 |
| Entity Type | Individual |
| Full Name | DR. ADAM DONALD WALLACE |
| Credential | MD |
| Practice Address |
200 1st St Sw Rochester MN 55905 |
| Mailing Address |
7974 Uw Health Ct Middleton WI 53562-5531 |
| Practice Telephone | 5072842511 |
| Mailing Telephone | 6088295485 |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2020-11-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
036145300 | IL | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
67056-20 | WI | Allopathic & Osteopathic Physicians |
| N | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
036145300 | IL | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
67056-20 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1386969079 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 1st St Sw, Rochester, MN 55905 | 5072842511 | |
| 744 S Webster Ave, Green Bay, WI 543013505 | 9204457222 | 9204457289 |
| 8201 E Riverside Blvd, Rockford, IL 611142300 | 8159712000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801117585 | Adam N Wallace | Radiology | 2301 N Lake Dr Ste 1104, Milwaukee, WI 53211-4508 | 2010-06-17 |
| 1518129733 | Adam Joseph Wallace | Anesthesiology | 3336 E 32nd St Ste 220, Tulsa, OK 74135-4442 | 2008-06-29 |
| 1700317898 | Adam Wallace | Student in an Organized Health Care Education/Training Program | 513 Parnassus Ave, S-321, San Francisco, CA 94143-2205 | 2017-03-21 |
| 1235450297 | Adam K Wallace | Nurse Anesthetist, Certified Registered | 616 19th St, Columbus, GA 31901-1528 | 2010-06-14 |
| Street Address |
200 1ST ST SW |
| City | ROCHESTER |
| State | MN |
| Zip Code | 55905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225031875 | Christine Maria Miller | Radiology | 200 1st St Sw, Rochester, MN 55905-0001 | 2005-05-27 |
| 1184225898 | Ellen Renne Larkin | Physical Therapist | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-11-08 |
| 1972104180 | Malinda Marie Wilcox | Nurse Practitioner | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-11-04 |
| 1720689920 | Tammy Lynn Perttula | Nurse Practitioner | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-11-04 |
| 1619578721 | Aaron Anderson | Physical Therapist | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-11-04 |
| 1093316598 | Rebecca Lea Parttridge | Nurse Practitioner | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-11-03 |
| 1710588173 | Eduardo Gabriel Danduch | Student in an Organized Health Care Education/Training Program | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-11-03 |
| 1962002030 | Taylor Jeanne Jamison | Physical Therapist | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-10-28 |
| 1619577640 | Hayden Taylor Middleton | Student in an Organized Health Care Education/Training Program | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-10-28 |
| 1295335461 | Vivek Sureshchandran Tharayil | Internal Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2020-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306333109 | John Warren Kirby | Radiology | 200 1st St Sw # 507284, Rochester, MN 55905 | 2018-04-17 |
| 1720528417 | Erin Hamilton | Social Worker | 200 First St. Sw, Rochester, MN 55905 | 2017-03-01 |
| 1033482872 | Mayo Foundation for Medical Education & Research | Durable Medical Equipment & Medical Supplies | 200 1st St Sw Ste S148, Rochester, MN 55905 | 2012-02-09 |
| 1871829937 | Karen Christine Lundholm | Pharmacist | 1216 2nd Street Sw, Rochester, MN 55905 | 2009-10-26 |
| 1689800260 | Matthew Basiaga | Pediatrics | 200 1st Ave Ne, Rochester, MN 55905 | 2009-06-09 |
| 1366680720 | Megan H. Nelson | Surgery | 200 First Street S.w., Rochester, MN 55905 | 2009-01-23 |
| 1639352198 | Jill Marie Hunchis | Nurse Practitioner | 200 First St Sw, Rochester, MN 55905 | 2007-12-07 |
| 1619027265 | Thomas Phillip Moyer | Spec/Tech, Pathology | 200 1st Street Southwest, H-730d, Rochester, MN 55905 | 2007-01-12 |
| 1568544070 | Lisa Ann Schimmenti | Medical Genetics | 200 1st Swst, Rochester, MN 55905 | 2006-10-20 |
| 1558302315 | Robert J Pignolo | Internal Medicine | 200 1st Street Sw, Rochester, MN 55905 | 2006-06-10 |
| Find all providers in zip 55905 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689093445 | Evelyn Olga Berman | Psychiatry & Neurology | 200 East River Rd, Rochester, NY 14623 | 2014-04-09 |
| 1811155625 | Yuliya Snyder | Psychiatry & Neurology | 1655 Elmwood Ave Ste 222, Rochester, NY 14620-3429 | 2008-05-29 |
| 1265448724 | Allison King | Psychiatry & Neurology | Child Neurology 601 Elmwood Ave, Box 631, Rochester, NY 14642-0001 | 2006-08-01 |
| 1346735750 | Hicham Dabaja | Psychiatry & Neurology | 200 1st St Sw, Rochester, MN 55905-0001 | 2018-06-27 |
| 1083033328 | Aubrey N Duncan | Psychiatry & Neurology | 601 Elmwood Ave Box 777r, Rochester, NY 14642-0001 | 2014-04-15 |
| 1548536998 | Jennifer Vermilion | Psychiatry & Neurology | 601 Elmwood Ave, Rochester, NY 14642-0001 | 2012-03-30 |
| 1285932517 | Marina Rubin Connolly | Psychiatry & Neurology | 601 Elmwood Ave, Box 278984, Rochester, NY 14642-0001 | 2011-03-10 |
| 1811211584 | Maria Joana Osorio | Psychiatry & Neurology | 601 Elmwood Ave, Rochester, NY 14642-0001 | 2010-03-24 |
| 1346408556 | Erika F Augustine | Psychiatry & Neurology | 601 Elmwood Ave, Rochester, NY 14642-0001 | 2008-05-26 |
| 1255455648 | Inna Hughes | Psychiatry & Neurology | 601 Elmwood Ave, Rochester, NY 14642-0001 | 2007-03-19 |
| Find all providers in ROCHESTER | ||||
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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.