Healthcare Provider Details

I. General information

NPI: 1851338891
Provider Name (Legal Business Name): RAMONA M WALLACE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. RAMONA M KWAPISZEWSKI

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MICHIGAN AVE
MARSHALL MI
49068-1580
US

IV. Provider business mailing address

93 SUNNYSIDE DR
BATTLE CREEK MI
49015-3154
US

V. Phone/Fax

Practice location:
  • Phone: 269-256-6625
  • Fax:
Mailing address:
  • Phone: 248-462-0684
  • Fax: 269-292-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: