| Donald R Wallace, MD | |
|
5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | |
| (309) 683-6600 | |
| Not Available |
| Full Name | Donald R Wallace |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 5114 N Glen Park Place Rd, Peoria, Illinois |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700899788 | NPI | - | NPPES |
| 800810 | Other | MEDICARE GROUP NO. | |
| 809840 | Other | IL | MEDICARE GROUP PTAN |
| 809840034 | Other | IL | MEDICARE INDIVIDUAL PTAN |
| 036077680 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 036-077680 (Illinois) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Donald R Wallace, MD 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 Ph: (309) 683-6600 | Donald R Wallace, MD 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 Ph: (309) 683-6600 |
Austin J Lamb, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 530 N.e. Glen Oak Avenue, Osf St. Francis, Emergency Medicine Residency Program, Peoria, IL 61637 Phone: 309-655-7257 |
Philip A Fifield, M.D. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602 |
Dr. Anthony J Buecker, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 221 Ne Glen Oak Ave, Peoria, IL 61636 Phone: 309-672-5500 |
Dr. Mark Phillip Gaudio, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-6710 |
Michael M Raso, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1115 N Bourland Ave, Peoria, IL 61606 Phone: 309-264-0730 |
Joseph Devito, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave Bldg Room2620, Peoria, IL 61637 Phone: 309-655-6710 |
Ryan Newberger, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 248-207-2018 |