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General NPI Number Information
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NPI Number | 1164827945
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Entity Type | Individual
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Provider Name | WILLIAM WALLEN MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 8333 NAAB RD STE 320
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1983
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Country | US
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Telephone | 317-338-3000
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Fax | 317-583-3099
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Provider Business Mailing Address
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Address Line | 100 WOODRUFF CIRCLE EMORY SCHOOL OF MEDICINE, SUITE 327
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City | ATLANTA
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State | GA
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Zip | 30322
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Country | US
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Telephone | 404-727-5658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | TP576
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 01097512A
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License Number State | IN
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