Dr MICHAEL J WALLACE is a male medical professional, specializing in Anesthesiology. He graduated in 1982 from University Of Texas Medical School At San Antonio.
BAYSIDE ANESTHESIA MEDICAL GROUP
1328 22ND ST
ST JOHNS HOSPITAL
SANTA MONICA
CA
904042091
Tel: 3104772465
| Npi | 1144304353 |
| Pac Id | 8921274762 |
| Professional Enrollment Id | I20111229000243 |
| Last Name | WALLACE |
| First Name | MICHAEL |
| Middle Name | J |
| Suffix | |
| Gender | M |
| Credential | |
| Medical School Name | UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO |
| Graduation Year | 1982 |
| Primary Specialty | ANESTHESIOLOGY |
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| Organization Legal Name | BAYSIDE ANESTHESIA MEDICAL GROUP |
| Group Practice Pac Id | 2466490560 |
| Number Of Group Practice Members | 46 |
| Line 1 Street Address | 1328 22ND ST |
| Line 2 Street Address | ST JOHNS HOSPITAL |
| Marker Of Address Line 2 Suppression | |
| City | SANTA MONICA |
| State | CA |
| Zip Code | 904042091 |
| Phone Number | 3104772465 |
| Hospital Affiliation Ccn 1 | 050290 |
| Hospital Affiliation Lbn 1 | PROVIDENCE SAINT JOHN'S HEALTH CENTER |
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| Professional Accepts Medicare Assignment | Y |
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