DR. JAMES ALFRED WALLACE (NPI# 1669687307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669687307 |
| Entity Type | Individual |
| Full Name | DR. JAMES ALFRED WALLACE |
| Credential | M.D. |
| Practice Address |
6701 159th St Suite 1 Tinley Park IL 60477-1758 |
| Mailing Address |
27702 Network Pl Chicago IL 60673-1277 |
| Practice Telephone | 7084442226 |
| Practice Fax Number | 7084442224 |
| Mailing Telephone | 7088627674 |
| Mailing Fax Number | 7088621781 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2018-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
036-113259 | IL | Allopathic & Osteopathic Physicians |
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
036-113259 | IL | Allopathic & Osteopathic Physicians |
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
036-113259 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036113259 | 05 | |
| IN | RR MEDICARE GROUP | CE1551 | 01 |
| IL | MEDICARE GROUP PTAN | 437901 | 01 |
| IL | R R MEDICARE INDIVIDUAL | P00634373 | 01 |
| IL | R R MEDICARE GROUP | CA8459 | 01 |
| IN | 200898350 | 05 | |
| IN | MEDICARE GROUP PTAN | 626820 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226005 | James D Wallace | Technician | 67 Don Dale Dr, Foster, WV 25081 | 2020-08-20 |
| 1982173571 | James Preston Wallace II | Clinic/Center | 6234 Castlegate Dr W Apt 8112, Castle Rock, CO 80108-8655 | 2018-11-13 |
| 1356686877 | James Steven Wallace | Physical Therapy Assistant | 449 Main St Apt 131, Anderson, IN 46016-1186 | 2012-12-10 |
| 1033400999 | James Wallace | Durable Medical Equipment & Medical Supplies | 593 Bramlett Way, Powder Springs, GA 30127 | 2011-04-27 |
| 1841591559 | James Leeman Wallace | Massage Therapist | 29650 Sw Courtside Dr, #14, Wilsonville, OR 97070-7482 | 2010-11-11 |
| 1992023212 | James Joseph Wallace | Specialist | 154 Sugar Cane Dr, Hartwell, GA 30643-8120 | 2010-05-11 |
| 1538338413 | James Christopher Wallace | Military Health Care Provider | Uss Ross, Ddg 71, Fpo, AE 09586-1288 | 2008-02-26 |
| 1568664274 | James Christopher Wallace | Emergency Medical Technician, Basic | Cgc Chase (whec-718) Fpo Ap 96662-3932 32nd St, San Diego, CA 92106 | 2007-06-04 |
| 1760683924 | James G Wallace Jr. | Family Medicine | 525 Jay Ave, Brewster, WA 98812-3403 | 2007-05-29 |
| 1922143882 | James B Wallace Jr. | Dentist | 6618 Fm 2100, Crosby, TX 77532 | 2007-02-20 |
| Street Address |
6701 159TH ST SUITE 1 |
| City | TINLEY PARK |
| State | IL |
| Zip Code | 60477-1758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124027651 | Frank J. Kniffen | Anesthesiology | 6701 159th St, Ingalls Same Day Surgery, Tinley Park, IL 60477-1758 | 2005-07-18 |
| 1659878635 | Lena Modieh | Nurse Practitioner | 6701 159th St, Tinley Park, IL 60477 | 2018-04-06 |
| 1740664630 | Annette Krapil | Pharmacist | 6701 159th St, Tinley Park, IL 60477-1758 | 2015-07-10 |
| 1063844934 | Primary Healthcare Associates, Sc | Non-Pharmacy Dispensing Site | 6701 159th St, Suite 1, Tinley Park, IL 60477-1758 | 2013-08-02 |
| 1154675700 | Donald A Williams Jr. | Physical Therapist | 6701 159th St, Tinley Park, IL 60477-1758 | 2012-11-05 |
| 1982953881 | Elizabeth Gezaw | Physical Therapist | 6701 159th St, Tinley Park, IL 60477-1758 | 2012-09-06 |
| 1487829990 | Medcentrix Inc. | Pharmacy | 6701 159th St, Tinley Park, IL 60477-1758 | 2008-04-25 |
| 1477747939 | Associated Urological Specialists LLC | Radiology | 6701 159th St, Tinley Park, IL 60477-1758 | 2007-08-28 |
| 1134257801 | Walid Kandah | Emergency Medicine | 6701 159th St, Tinley Park, IL 60477-1758 | 2007-03-02 |
| 1467588061 | Amjad Akhtar | Emergency Medicine | 6701 159th St, Tinley Park, IL 60477-1758 | 2007-02-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013522366 | Joshua Gruenke | Physical Therapist | 17129 S. Harlem Avenue, Tinley Park, IL 60477 | 2020-09-14 |
| 1881229656 | Sherrie Lynn Tsang | Massage Therapist | 7925 West 171st Street, Tinley Park, IL 60477 | 2020-03-11 |
| 1437782117 | Du Page Medical Group Ltd | Durable Medical Equipment & Medical Supplies | 17129 S Harlem Ave. Ste B3, Tinley Park, IL 60477 | 2020-02-20 |
| 1356998561 | Rasa Vaskeviciute | Physical Therapist | 17129 So Harlem, Tinley Park, IL 60477 | 2019-08-22 |
| 1538728258 | Michelle Anne Wisen | Physical Therapy Assistant | 17129 South Harlem, Suite B3, Tinley Park, IL 60477 | 2019-06-06 |
| 1073006151 | Danielle Lyon | Counselor | 6801 West 180th Court, Tinley Park, IL 60477 | 2018-06-13 |
| 1316445794 | Yvonne Tran | Physical Therapist | 17129 S Harlem Ave, Tinley Park, IL 60477 | 2018-01-31 |
| 1326574591 | Nicholas Barker | Chronic Disease Hospital | 7859 Joliet Drive North, Tinley Park, IL 60477 | 2017-05-10 |
| 1982063632 | Nicole Kristine Demarco | Specialist/Technologist | 16317 Clark Ln, Tinley Park, IL 60477 | 2016-02-22 |
| 1376900571 | Ucp Seguin Greater Chicago | Foster Care Agency | 7550 W. 183rd, Tinley Park, IL 60477 | 2016-01-20 |
| Find all providers in zip 60477 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730634700 | Liyun Huang | Internal Medicine | 17495 South La Grange Rd, Tinley Park, IL 60487 | 2016-08-19 |
| 1659461010 | John Michael Mckeown | Internal Medicine | 16532 S. Oak Park Ave, Suite 102, Tinley Park, IL 60477-2280 | 2006-10-13 |
| 1598750101 | Saoud Loutfi | Internal Medicine | 17495 La Grange Rd, Tinley Park, IL 60487-7581 | 2005-09-20 |
| 1992797047 | Vasia A Ahmed | Internal Medicine | 17333 La Grange Rd Ste 200, Tinley Park, IL 60487-7510 | 2005-08-16 |
| 1316236524 | Mylene Hernandez Remo | Internal Medicine | 17333 La Grange Rd Ste 200, Tinley Park, IL 60487-7510 | 2011-03-29 |
| 1255656948 | Surekha Boddipalli | Internal Medicine | 17495 La Grange Rd, Tinley Park, IL 60487-7581 | 2010-04-06 |
| 1760625867 | Alpha Med Physicians Group, LLC | Internal Medicine | 17333 La Grange Rd, Suite 200, Tinley Park, IL 60487-7502 | 2009-04-20 |
| 1427218452 | Vasantha Kumaraiah,md,sc | Internal Medicine | 17732 Oak Park Ave, Suite E, Tinley Park, IL 60477-3934 | 2008-06-12 |
| 1427255447 | Shadi Latta | Internal Medicine | 17333 La Grange Rd Ste 200, Tinley Park, IL 60487-7510 | 2007-07-02 |
| 1083704449 | Cancer Care Specialists, Ltd. | Internal Medicine | 16532 S. Oak Park Ave, Suite 102, Tinley Park, IL 60477-2280 | 2006-10-13 |
| Find all providers in TINLEY PARK | ||||
| City | TINLEY PARK |
| Zip Code | 60477 |
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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.