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1750871455
KACIE WALLACE
DETROIT, MI
NPI
1750871455
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MI 1151843)
Enumeration Date
2018-05-17
Last Update Date
2019-09-15
Business Address
KACIE WALLACE M.S., PA-C
22101 MOROSS RD
DETROIT, MI 48236-2148
Phone number: 313-343-4000
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Mailing Address
KACIE WALLACE M.S., PA-C
226 WIMPOLE DR
ROCHESTER HILLS, MI 48309-2148
Phone number: 248-720-8197
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