Lance T Wallace, M.D.

NPI #1538100128 in Matteson, Illinois

Provider Information

NPI Number: 1538100128
Entity Type: Individual
Name: Lance T Wallace, M.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Internal Medicine
Credential: M.D.
Enumeration Date: Jun 8, 2006
Last Updated: Mar 15, 2021

Practice Location

Address: 20939 S CICERO AVE
City: Matteson
State: Illinois
ZIP Code: 60443-1620
Phone: (708) 709-9375

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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