| David Wallace, MD | |
|
340 W Lincoln St, Belleville, IL 62220-1900 | |
| (618) 233-6044 | |
| (618) 233-3287 |
| Full Name | David Wallace |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine - Cardiovascular Disease |
| Location | 340 W Lincoln St, Belleville, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609804525 | NPI | - | NPPES |
| 0360929191 | Medicaid | IL | |
| 107076 | Other | MO | BCBS MO |
| 2501200 | Other | SECURE HORIZONS | |
| 37099690008 | Other | GHP | |
| E43629 | Other | MERCY | |
| 12269 | Other | ESSENCE | |
| 060046618 | Other | RR MEDICARE | |
| 1734162 | Other | UHC | |
| 205943608 | Medicaid | MO | |
| 235649 | Other | HEALTHLINK | |
| 235649 | Other | WELLCARE | |
| 093355 | Other | HEALTH ALLIANCE | |
| 54656 | Other | CMR | |
| P01024928 | Other | IL | RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RC0000X | Internal Medicine - Cardiovascular Disease | 036092919 (Illinois) | Primary |
| Entity Name | Prairie Cardiovascular Consultants Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659539559 PECOS PAC ID: 3173435880 Enrollment ID: O20031111000337 |
| Entity Name | St Elizabeths Hospital Of The Hospital Sisters Of The Third Order |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1194736728 PECOS PAC ID: 6406753011 Enrollment ID: O20031212000629 |
| Entity Name | St Josephs Hospital Breese Of The Hospital Sisters Of The Third Orde |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1457319154 PECOS PAC ID: 9638064892 Enrollment ID: O20040217000493 |
| Mailing Address | Practice Location Address |
|---|---|
| David Wallace, MD 340 W Lincoln St, Belleville, IL 62220-1900 Ph: (618) 233-6044 | David Wallace, MD 340 W Lincoln St, Belleville, IL 62220-1900 Ph: (618) 233-6044 |
Dr. Dennis P Larson, M.D. Cardiovascular Disease Medicare: Not Enrolled in Medicare Practice Location: 509 E Waters Edge Dr, Belleville, IL 62221 Phone: 618-235-1510 Fax: 618-235-1502 | |
Kathleen K Fournier, MD Cardiovascular Disease Medicare: Not Enrolled in Medicare Practice Location: 4600 Memorial Dr, Suite 100, Belleville, IL 62226 Phone: 618-222-9999 Fax: 618-222-9337 | |
Eldon Trame, M.D. Cardiovascular Disease Medicare: Not Enrolled in Medicare Practice Location: 2900 Frank Scott Pkwy W, Suite 904, Belleville, IL 62223 Phone: 618-234-0640 Fax: 314-851-4475 | |
Dr. Vibhu Dhawan, MD Cardiovascular Disease Medicare: Accepting Medicare Assignments Practice Location: 4500 Memorial Dr, Belleville, IL 62226 Phone: 618-257-6220 | |
Anand P. Patel, MD Cardiovascular Disease Medicare: Medicare Enrolled Practice Location: 4500 Memorial Dr, Belleville, IL 62226 Phone: 618-257-6220 | |
Kashif Shahzad Bhutto, MD Cardiovascular Disease Medicare: Accepting Medicare Assignments Practice Location: 4600 Memorial Dr Ste 200, Belleville, IL 62226 Phone: 618-233-2220 Fax: 618-233-2555 | |
Dr. David Nelson Pfohl, MD, FACP, GAQ Cardiovascular Disease Medicare: Not Enrolled in Medicare Practice Location: 45 Pebble Hill Dr, Belleville, IL 62223 Phone: 618-604-6518 |