Provider Demographics
NPI:1093033011
Name:PALKO, JILL M (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:PALKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1390
Mailing Address - Country:US
Mailing Address - Phone:815-786-1088
Mailing Address - Fax:815-786-1314
Practice Address - Street 1:831 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1390
Practice Address - Country:US
Practice Address - Phone:815-786-1088
Practice Address - Fax:815-786-1314
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137111207V00000X
IL036135216207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400193282Medicare PIN