TIMOTHY M WALLACE (NPI# 1720013121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720013121 |
| Entity Type | Individual |
| Full Name | TIMOTHY M WALLACE |
| Credential | MD |
| Practice Address |
36500 Aurora Dr Summit WI 53066-4899 |
| Mailing Address |
8901 W Lincoln Ave West Allis WI 53227-2409 |
| Practice Telephone | 2624343741 |
| Practice Fax Number | 2624343702 |
| Mailing Telephone | 4143287950 |
| Mailing Fax Number | 4143288505 |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
41030 | WI | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063438307 | Timothy Mark Wallace | Chiropractor | 4357 Phelan Rd, Phelan, CA 92371-7675 | 2006-07-13 |
| 1437149739 | Timothy R Wallace | Psychologist | 125 Nashua Street, Spaulding Rehab Hospital, Boston, MA 02114-1198 | 2005-10-27 |
| 1619527611 | Timothy Wallace | Case Manager/Care Coordinator | 774 Internet Dr, Columbus, OH 43207-2589 | 2019-09-12 |
| 1396987657 | Timothy Brian Wallace II | Anesthesiology | 550 Peachtree St Ne, Atlanta, GA 30308-2212 | 2009-04-01 |
| 1003072414 | Timothy Thomas Wallace Jr. | Registered Nurse | 10000 Brecksville Rd, Brecksville, OH 44141-3204 | 2008-08-05 |
| 1275725384 | Timothy R Wallace | Family Medicine | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2007-08-13 |
| 1033328703 | Timothy J Wallace | Radiology | 401 College St, Richmond, VA 23298-5017 | 2007-05-21 |
| 1841215902 | Timothy Brian Wallace | Anesthesiology | 6605 Abercorn St, Suite 108, Savannah, GA 31405-5815 | 2006-07-12 |
| 1700850674 | Timothy Wallace | Physician Assistant | 450 Clarkson Ave, Box 56, Brooklyn, NY 11203-2056 | 2006-02-15 |
| Street Address |
36500 AURORA DR |
| City | SUMMIT |
| State | WI |
| Zip Code | 53066-4899 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346242518 | Janice Mary Beaton | Audiologist | 36500 Aurora Dr, Summit, WI 53066-4899 | 2005-06-01 |
| 1821697863 | Mackenzie L Sinnen | Audiologist | 36500 Aurora Dr, Summit, WI 53066-4899 | 2020-10-21 |
| 1811515661 | Kira Greenwood | Dietitian, Registered | 36500 Aurora Dr, Summit, WI 53066-4899 | 2020-07-08 |
| 1588281802 | Makenzie A Kirk | Physician Assistant | 36500 Aurora Dr, Summit, WI 53066-4899 | 2020-07-02 |
| 1619598786 | Olivia Joi Carlton | Physical Medicine & Rehabilitation | 36500 Aurora Dr, Summit, WI 53066-4899 | 2020-04-30 |
| 1477186633 | Aurora Advanced Healthcare Inc | Durable Medical Equipment & Medical Supplies | 36500 Aurora Dr, Summit, WI 53066-4899 | 2020-02-17 |
| 1285279844 | Elizabeth Daniels | Physician Assistant | 36500 Aurora Dr, Summit, WI 53066-4899 | 2019-11-07 |
| 1265076087 | Jessica M Zuerner | Nurse Practitioner | 36500 Aurora Dr, Summit, WI 53066-4899 | 2019-11-05 |
| 1043860570 | Megan E Shea | Physician Assistant | 36500 Aurora Dr, Summit, WI 53066-4899 | 2019-09-17 |
| 1740835073 | Kristal D Timm | Nurse Practitioner | 36500 Aurora Dr, Summit, WI 53066-4899 | 2019-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376109082 | Sharon Legwinski | Occupational Therapist | 2195 N. Summit Way, Oconomowoc, WI 53066 | 2019-05-17 |
| 1033676390 | Paladina Health, LLC | Family Medicine | Paladina Health Oconomowoc Sentry Equipment Circle, 966 Blue Ribbon Circle N, Oconomowoc, WI 53066 | 2019-02-22 |
| 1689145500 | Oconomowoc Developmental Training Center of Wisconsin LLC | Residential Treatment Facility, Emotionally Disturbed Children | 36100 Genesee Lake School, Oconomowoc, WI 53066 | 2018-12-17 |
| 1649748203 | Ginny Dacquisto | Dietitian, Registered | 1134 Lily Rd, Oconomowoc, WI 53066 | 2018-11-12 |
| 1174000764 | Aimee M Metzger | Social Worker | 405 E Forest St Ste 113, Oconomowoc, WI 53066 | 2018-07-26 |
| 1023482569 | Forefront Dermatology, S.c. | Dermatology | 1320 Pabst Farms Cir, Suite 180, Oconomowoc, WI 53066 | 2015-11-20 |
| 1962890475 | Monica Rodriguez | Counselor | 405 East Forest Street, Suite 119, Oconomowoc, WI 53066 | 2015-01-06 |
| 1518384643 | Kimberley Bevan | Pharmacist | 1284 East Summit Avenue, Suite 100, Oconomowoc, WI 53066 | 2014-03-26 |
| 1699098905 | Heidi Eckroth Nunnemacher | Counselor | 35315 Genesee Lake Road, Oconomowoc, WI 53066 | 2010-03-02 |
| 1669705240 | Oconomowoc Development Training Center Ll | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3222 N. Silver Cedar Rd., Oconomowoc, WI 53066 | 2009-09-14 |
| Find all providers in zip 53066 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477702124 | Miles B Levin | Pathology | 99 Beauvoir Ave, Overlook Hospital 3rd Floor Pathology, Summit, NJ 07901-3533 | 2008-09-17 |
| 1366530693 | Mona Labat | Pathology | 99 Beauvoir Ave, Pathology Department, Summit, NJ 07901-3533 | 2006-10-11 |
| 1407940240 | Prabha Pai | Pathology | 99 Beauvoir Ave, Summit, NJ 07901-3533 | 2006-10-03 |
| 1821182668 | Sushama Dileep Karmarkar | Pathology | 99 Beauvoir Ave, Summit, NJ 07901-3533 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992316533 | Andrii Puzyrenko | Pathology | 9200 W Wisconsin Ave Ste L83, Milwaukee, WI 53226-3522 | 2020-08-16 |
| 1487040127 | Michelle Stoffel | Pathology | Uw Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 | 2015-04-09 |
| 1447694328 | Patrick Stephen Rush | Pathology | 600 Highland Ave. H4/831, Uw Hospital and Clinics, Madison, WI 53792 | 2013-04-23 |
| 1346501756 | James Murray Angevine | Pathology | 602 Mineral Pt Road, Apt 214, Madison, WI 53705-4577 | 2012-06-01 |
| 1023314549 | Stephen Lee Mcclellan | Pathology | N4656 Lakeshore Dr, Kewaunee, WI 54216-9794 | 2011-01-31 |
| 1922231414 | Darrell Peter Skarphol | Pathology | 2480 Edgewood Ct, Green Bay, WI 54302-4813 | 2009-08-31 |
| 1518110147 | Werner Adam Reis | Pathology | 839 N Jefferson St Ste 300, Milwaukee, WI 53202-3744 | 2008-10-28 |
| 1598927444 | Leela C Thachenkary | Pathology | 7107-49th Ave, Kenosha, WI 53142 | 2008-07-01 |
| 1326211384 | Scott James Kantola | Pathology | 2800 Westhill Dr Ste 208, Wausau, WI 54401-3770 | 2008-04-10 |
| 1437355997 | Monica Goswami | Pathology | 10472 W Montana Ave, # 215, West Allis, WI 53227-3263 | 2007-06-22 |
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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.