MEDICARE: WALLY FOLAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	49722	KY
2	208M00000X	Hospitalist Physician	17389	NV
3	207R00000X	Internal Medicine Physician	50944	TN
4	208M00000X	Hospitalist Physician	50944	TN
5	207R00000X	Internal Medicine Physician	17389	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01505983	OTHER	TN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6039779	OTHER	TN	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1326331893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALLY FOLAD M.D.

Provider Business Mailing Address
First Line	:	300 20TH AVE N STE 403
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-5180
Country	:	US
Telephone Number	:	615-284-7224
Fax Number	:	615-284-7501

Provider Business Practice Location Address
First Line	:	6166 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3912
Country	:	US
Telephone Number	:	725-223-4100
Fax Number	:	865-560-7110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	11/12/2024

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Directions to “ WALLY FOLAD M.D.” Practice Location

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