Provider Demographics
NPI:1053313080
Name:PALLANTE, ELIZABETH FISHER (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FISHER
Last Name:PALLANTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:766 OAKMERE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2874
Mailing Address - Country:US
Mailing Address - Phone:231-719-8517
Mailing Address - Fax:
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-737-0411
Practice Address - Fax:231-739-8502
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051402208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2929016Medicaid
MIFO1785Medicare UPIN