David B. Wallace, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036050183 Issued in IL

Practice address

325 N Highland Ave
Provena Mercy Medical Center
Aurora, IL 60506-3811

Phone

(630) 859-2222

NPI assigned

Aug 4, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1295736809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E 22ND ST",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601486110",
            "telephone_number": "630-874-2542",
            "fax_number": "630-874-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N HIGHLAND AVE",
            "address_2": "PROVENA MERCY MEDICAL CENTER",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605063811",
            "telephone_number": "630-859-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DAVID",
        "middle_name": "B.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-04",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036050183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Walinski, DO
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• Emma F Wallis
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• Walmart Inc.

• Diagnostic Radiology Physician in Aurora, IL
• Providers in Aurora, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.