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1659488690
BRIAN KEN WALLACE
MILWAUKEE, WI
NPI
1659488690
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: WI 27108)
Enumeration Date
2006-08-24
Last Update Date
2023-09-22
Business Address
Dr. BRIAN KEN WALLACE MD
2801 W KINNICKINNIC RIVER PKWY #250
MILWAUKEE, WI 53215
Phone number: 414-649-6732
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Mailing Address
Dr. BRIAN KEN WALLACE MD
PO BOX 735044
CHICAGO, IL 60673-5044
Phone number: 414-649-6732
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