Provider Demographics
NPI:1285618231
Name:VALLANCE, DAVID KIRKLAND (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KIRKLAND
Last Name:VALLANCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3055 PLYMOUTH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3208
Mailing Address - Country:US
Mailing Address - Phone:734-623-0100
Mailing Address - Fax:734-623-0101
Practice Address - Street 1:3055 PLYMOUTH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3208
Practice Address - Country:US
Practice Address - Phone:734-623-0100
Practice Address - Fax:734-623-0101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053286207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48166Medicare UPIN
N99380001Medicare ID - Type Unspecified