DENNIS LEE WALLACE P.A. NPI 1396790986

NPI Information

  • NPI: 1396790986
  • Provider Name: DENNIS LEE WALLACE, P.A.
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • Address: 4100 BEECHER RD
    SUITE A
    FLINT, MI
    ZIP 48532
  • Phone: (810) 342-3800

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NPI Details

Dennis Lee Wallace, P.A. is a medical physician assistant in Flint, MI. Dennis Lee Wallace, P.A. NPI is 1396790986. 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:

4100 BEECHER RD
SUITE A
FLINT, MI
ZIP 48532-661
Phone: (810) 342-3800
Fax: (810) 342-3784

The enumeration date for this NPI number is 5/23/2006 and was last updated on 8/11/2010.

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
1363AM0700XPhysician AssistantMedical5601002261MICHIGANYes

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
10N96090MEDICARE ID-TYPE UNSPECIFIEDMICHIGAN

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: 11/21/2025

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