DR. ADAM DONALD WALLACE MD NPI 1386969079

NPI Information

NPI: 1386969079
Provider Name: DR. ADAM DONALD WALLACE, MD
Classification: Psychiatry & Neurology - 2084N0402X
Entity Type: Individual

Specialization: Neurology with Special Qualifications in Child Neurology

PECOS Registration: Yes

Address:
200 1ST ST SW
ROCHESTER, MN
ZIP 55905
Phone: (507) 284-2511
Get Directions

DR. Adam Donald Wallace, MD is a neurology with special qualifications in child neurology psychiatry neurology in Rochester, MN. The provider is a Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. DR. Adam Donald Wallace, MD NPI is 1386969079. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

200 1ST ST SW
ROCHESTER, MN
ZIP 55905
Phone: (507) 284-2511

The NPI 1386969079 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), Power Mobility Devices.

The enumeration date for this NPI number is 4/6/2010 and was last updated on 12/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0400X	Psychiatry & Neurology	Neurology	036145300	ILLINOIS	No
2	2084N0400X	Psychiatry & Neurology	Neurology	67056-20	WISCONSIN	No
3	2084N0402X	Psychiatry & Neurology	Neurology with Special Qualifications in Child Neurology	036145300	ILLINOIS	No
4	2084N0402X	Psychiatry & Neurology	Neurology with Special Qualifications in Child Neurology	67056-20	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1386969079	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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