Kevin R Wallace (NPI# 1053423285, PAC ID# 1951691237) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ORAL SURGERY.
| Nation Provider ID (NPI) | 1053423285 |
| PAC ID by PECOS | 1951691237 |
| Professional Enrollment ID | I20160620000860 |
| Full Name | Kevin R Wallace |
| Organization Legal Name | DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD |
| Address |
150 E Huron St Suite 1103 Chicago IL 60611-2948 |
| Phone Number | 3126769893 |
| Gender | M |
| Graduation Year | 1990 |
| Primary Specialty | ORAL SURGERY |
| Group Practice PAC ID | 8820287121 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | M |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140281 | NORTHWESTERN MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 150 E Huron St, Suite 1103, Chicago, IL 60611-2948 | 3126769893 | DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD |
| Organization Legal Name | DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brian A Prentice | Dentist | Dental Sleep Center Richard A Craig Dds Ltd | 120 Oak Brook Ctr, Suite 726, Oak Brook, IL 60523-4754 |
| Richard A Craig | Dentist | Dental Sleep Center Richard A Craig Dds Ltd | 220 Channahon St, Shorewood, IL 60404-9330 |
| Ivan A Valcarenghi | Dentist | Dental Sleep Center Richard A Craig Dds Ltd | 4711 Golf Rd, Suite 413, Skokie, IL 60076-1242 |
| Charles F Lockhart | Oral Surgery | Dental Sleep Center Richard A Craig Dds Ltd | 220 Channahon St, Shorewood, IL 60404-9330 |
| Street Address |
150 E HURON ST SUITE 1103 |
| City | CHICAGO |
| State | IL |
| Zip | 60611-2948 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dina Yaghmai | Dermatology | Physicians Laser and Dermatology Institute of Chicago LLC | 150 E Huron St, Suite 1050, Chicago, IL 60611-2999 |
| Catherine Cheng | Internal Medicine | Northwestern Medical Faculty Foundation | 150 E Huron St, Suite 1100, Chicago, IL 60611-2948 |
| Bruce L Dresner | Psychiatry | 150 E Huron St, Suite 1101, Chicago, IL 60611-2948 | |
| Jane A Mockaitis | Registered Dietitian Or Nutrition Professional | Northwestern Medical Faculty Foundation | 150 E Huron St, Suite 1100, Chicago, IL 60611-2948 |
| Melinda R Ring | Internal Medicine | Northwestern Medical Faculty Foundation | 150 E Huron St, Suite 1100, Chicago, IL 60611-2948 |
| Melody Tran | Physical Therapy | Accelerated Rehabilitation Centers Ltd | 150 E Huron St, Suite 700, Chicago, IL 60611-2999 |
| Howard S Feldman | Psychologist, Clinical | Northwestern Medical Faculty Foundation | 150 E Huron St, Suite 1100, Chicago, IL 60611-2948 |
| Amanda Murabito | Physical Therapy | Accelerated Rehabilitation Centers Ltd | 150 E Huron St, Suite 700, Chicago, IL 60611-2999 |
| Ronald M Reiss | Chiropractic | 150 E Huron St, Suite 802, Chicago, IL 60611-2912 | |
| Jerome M Garden | Dermatology | Physicians Laser and Dermatology Institute of Chicago LLC | 150 E Huron St, Suite 1050, Chicago, IL 60611-2999 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joseph R Spatafora | Psychiatry | 600 N Mcclurg Court, Suite 4411a, Chicago, IL 60611 | |
| Barbara S Rocah | Psychiatry | 1110 N Lake Shore Dr, Apt 30s, Chicago, IL 60611-1022 | |
| Loretta De Koster | Optometry | 129 E Oak St, Chicago, IL 60611-1202 | |
| Robert Lee Walton Jr. | Plastic and Reconstructive Surgery | 60 E Delaware Pl, Suite 1430, Chicago, IL 60611-1495 | |
| Michael R Abern | Urology | The Board of Trustees of The University of Illinois | 900 N Michigan Ave, Chicago, IL 60611-1542 |
| Lawrence S Ross | Urology | The Board of Trustees of The University of Illinois | 900 N Michigan Ave, Chicago, IL 60611-1542 |
| Kelly Dineen | Psychologist, Clinical | One E Delaware Place, Suite 501, Chicago, IL 60611-1666 | |
| Charles Zugerman | Dermatology | Illinois Dermatology Institute LLC | 1 E Delaware Pl, Suite 501, Chicago, IL 60611-1666 |
| Jacob Mp Bloom | Plastic and Reconstructive Surgery | 1 E Delaware Pl, Suite 501, Chicago, IL 60611-1666 | |
| Mark I Golden | Ophthalmology | 875 N Michigan Ave, Suite 1550, Chicago, IL 60611-1886 | |
| Find all physicians in zip 60611 | |||
| City | CHICAGO |
| Zip Code | 60611 |
| Specialty | ORAL SURGERY |
| City + Specialty | CHICAGO + ORAL SURGERY |
Please comment or provide details below to improve the information on Kevin R Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.