DR. DOUGLAS CHARLES WALLACE M.D. NPI 1851470033

NPI Information

NPI: 1851470033
Provider Name: DR. DOUGLAS CHARLES WALLACE, M.D.
Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
Entity Type: Individual
Address: 3900 ST FRANCIS WAY
STE 201
LAFAYETTE, IN
ZIP 47905
Phone: (765) 446-7981

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NPI Details

DR. Douglas Charles Wallace, M.D. is a thoracic surgery cardiothoracic vascular surgery in Lafayette, IN. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. DR. Douglas Charles Wallace, M.D. NPI is 1851470033. 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:

3900 ST FRANCIS WAY
STE 201
LAFAYETTE, IN
ZIP 47905-923
Phone: (765) 446-7981
Fax: (765) 446-7982

The enumeration date for this NPI number is 11/6/2006 and was last updated on 12/19/2012.

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	License Number	License State	Primary
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)	G66727	CALIFORNIA	No
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)	036-101410	ILLINOIS	No
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)	01071946A	INDIANA	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	256510001	MEDICARE PIN	ILLINOIS
2	036112410	MEDICAID	ILLINOIS

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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