Provider Demographics
NPI:1144245994
Name:PALMER, SCOTT B (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-942-4040
Mailing Address - Fax:312-563-2545
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:SUITE 212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-942-4040
Practice Address - Fax:312-563-2545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
31603295OtherBCBS
IL036074836Medicaid
110027669OtherRAILROAD MEDICARE
110027669OtherRAILROAD MEDICARE
C45226Medicare UPIN