Kimberly Wallace MD PC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

KIMBERLY WALLACE MD PC

Practice address

12900 W 9 Mile Road
Oak Park, MI 48237

Phone

(248) 547-9292

NPI assigned

Oct 14, 2019

Organization subpart

No

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

Authorized official

Name

Kimberly Wallace, MD

Title

President

Phone

(248) 547-9292

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Luke Jordan, M.D.

  • Obstetrics & Gynecology Physician
  • Oak Park, MI
  • NPI 1497744932
  NPD

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1497397202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 700263",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 W 9 MILE ROAD",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "48237",
            "telephone_number": "248-547-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY WALLACE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-14",
        "last_updated": "2019-11-13",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-547-9292",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matiullah Khan, PT, DPT
• Iaman Khrais, LLMSW
• Kidney Centers of Michigan LLC
• Tina Killiany, LPN
• Kimberly Kim, O.D.
• Deniene King, NP-C
• Jalita King, PMH-NP
• Wafid W Kizy, DMD
• Mary Jane Kosal, LMSW
• Yocheved Kresch

• Medical Specialty Clinic/Center in Oak Park, MI
• Providers in Oak Park, MI by specialty
• Medical Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.