Provider Demographics
NPI:1184672479
Name:KREISBERG PALMER, MICHELE (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:KREISBERG PALMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1101 4TH ST STE 313
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1952
Practice Address - Country:US
Practice Address - Phone:720-226-1448
Practice Address - Fax:712-560-8247
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004466174400000X
CO7232174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COHO675746OtherBLUE SHIELD
C806277OtherMEDICARE PTAN
COC806281Medicare PIN
C806277OtherMEDICARE PTAN