Provider Demographics
NPI:1023213147
Name:PALOMINO, MICHAEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTONIO
Last Name:PALOMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 W. 21ST ST. N.
Mailing Address - Street 2:BUILDING 1042 SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-854-3526
Mailing Address - Fax:
Practice Address - Street 1:7570 W. 21ST ST. N.
Practice Address - Street 2:BUILDING 1042 SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-854-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS046712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200664530AMedicaid