Blake Taylor Wallace, DPM is a student in an organized health care education training program in Indianapolis, IN. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Blake Taylor Wallace, DPM NPI is 1083216949. The provider is registered as an individual entity type and is a single specialty group.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
8414 NAAB RD STE 215
INDIANAPOLIS, IN
ZIP 46260-972
Phone: (317) 338-7510
The NPI 1083216949 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).
The enumeration date for this NPI number is 11/14/2020 and was last updated on 3/24/2021.