| Doctor Name: | KIMBERLY WALLACE |
| NPI Number: | 1750327045 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4301084456 |
| Business Practice Address: | 28555 Orchard Lake Rd Ste. 120 Farmington Hills, MI - 483342973 |
| Business Phone Number: | 2484891070 |
| Business Fax Number: | |
| Mailing Address: | 3601 W 13 Mile Rd, 400-fsc/pcs ROYAL OAK |
| State: | MI |
| Postal Code: | 480736712 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 4301084456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |