| Elizabeth Nicole Wallis, MD | |
|
200 W Monroe St Ste 302, Bloomington, IL 61701-3997 | |
| (309) 204-6766 | |
| Not Available |
| Full Name | Elizabeth Nicole Wallis |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 200 W Monroe St Ste 302, Bloomington, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821551334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 036.176418 (Illinois) | Secondary |
| 208000000X | Pediatrics | 331615 (Louisiana) | Primary |
| Entity Name | South Louisiana Medical Associates |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942301379 PECOS PAC ID: 8527968650 Enrollment ID: O20040113000589 |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth Nicole Wallis, MD 200 W Monroe St Ste 302, Bloomington, IL 61701-3997 Ph: (309) 204-6766 | Elizabeth Nicole Wallis, MD 200 W Monroe St Ste 302, Bloomington, IL 61701-3997 Ph: (309) 204-6766 |
Dr. Aaron Reid Traeger, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 3024 E Empire St, Bloomington, IL 61704 Phone: 309-556-7337 |
Stephen Trainor, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 302 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-664-3100 Fax: 309-664-3027 |
Dr. Sanjay Saxena, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2427 Maloney Dr, Bloomington, IL 61704 Phone: 309-663-1011 Fax: 309-665-0825 |
Mrs. Chalermlarp Mongkolsmai, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2206 Berrywood Ln, Bloomington, IL 61704 Phone: 309-662-2032 |
Dr. Jodie Dewey, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 302 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-664-3100 Fax: 309-664-3027 |
Dr. Andrea Michelle Kane, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3024 E Empire St, Bloomington, IL 61704 Phone: 309-556-7337 |
Dr. Jean Marie Kolb, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 501a S Towanda Barnes Rd Ste 2, Bloomington, IL 61705 Phone: 309-612-9002 |