Provider Demographics
NPI:1003808858
Name:ABEL, WALLACE K (MD)
Entity Type:Individual
Prefix:
First Name:WALLACE
Middle Name:K
Last Name:ABEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:311 W LINCOLN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1902
Mailing Address - Country:US
Mailing Address - Phone:618-234-2566
Mailing Address - Fax:618-234-5650
Practice Address - Street 1:311 W LINCOLN ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1902
Practice Address - Country:US
Practice Address - Phone:618-234-2566
Practice Address - Fax:618-234-5650
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-076085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
103950OtherHEALTH ALLIANCE
678480001OtherDMERC
1161218OtherUHC/COMMERCIAL
80015976OtherRR MEDICARE
118809OtherHEALTHLINK
166406OtherGROUP HEALTH PLAN
7942001OtherAETNA
MO14796OtherBLUE CROSS BLUE SHIELD
IL932248051OtherBLUE CROSS BLUE SHIELD
166406OtherGROUP HEALTH PLAN
103950OtherHEALTH ALLIANCE