| Dr Gabriel Abraham Wallace, MD | |
|
12251 S 80th Ave Ste 1520, Palos Heights, IL 60463-1290 | |
| (708) 923-4200 | |
| (708) 923-4201 |
| Full Name | Dr Gabriel Abraham Wallace |
|---|---|
| Gender | Male |
| Speciality | Vascular Surgery |
| Experience | 14 Years |
| Location | 12251 S 80th Ave Ste 1520, Palos Heights, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609142074 | NPI | - | NPPES |
| 036142476 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 036142476 (Illinois) | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | 036142476 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Palos Community Hospital | Palos heights, IL | Hospital |
| Central Dupage Hospital | Winfield, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Northwestern Medical Faculty Foundation | 4587576814 | 3871 |
| Entity Name | Northwestern Medical Faculty Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1346235314 PECOS PAC ID: 4587576814 Enrollment ID: O20031105000541 |
| Entity Name | Vascular Surgery Associates Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1538791793 PECOS PAC ID: 0345678132 Enrollment ID: O20200309002184 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Gabriel Abraham Wallace, MD Po Box 84992, Chicago, IL 60689-4992 Ph: (918) 710-3710 | Dr Gabriel Abraham Wallace, MD 12251 S 80th Ave Ste 1520, Palos Heights, IL 60463-1290 Ph: (708) 923-4200 |
Franjo Siric, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 12251 S 80th Ave Ste 1520, Palos Heights, IL 60463 Phone: 708-923-4200 Fax: 708-923-4448 | |
Nandan Nath, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 12251 S 80th Ave Ste 1520, Palos Heights, IL 60463 Phone: 708-923-4200 Fax: 708-923-4201 | |
Dr. Imad Qayyum, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 12255 S 80th Ave, Palos Heights, IL 60463 Phone: 708-923-4400 Fax: 708-923-4421 | |
Ijaz Qayyum, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 12251 S 80th Ave, St. George Ambulatory Center, Palos Heights, IL 60463 Phone: 708-923-4400 Fax: 708-923-4421 | |
Samer Rodwan Rajjoub, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 12251 S 80th Ave, St. George Ambulatory Center, Palos Heights, IL 60463 Phone: 708-923-4400 Fax: 708-923-4421 |