Provider Demographics
NPI:1255329249
Name:PALMER, SHAWN W (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:W
Last Name:PALMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735263
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5944
Practice Address - Country:US
Practice Address - Phone:815-398-9491
Practice Address - Fax:815-381-7498
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098847207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE6001OtherRAILROAD MEDICARE GROUP-KANE COUNTY
CG2631OtherRAILROAD MEDICARE MCHENRY COUNTY
IL036098847Medicaid
P00205874OtherRAILROAD MEDICARE PIN
IL036098847Medicaid
K16273Medicare PIN
CE6001OtherRAILROAD MEDICARE GROUP-KANE COUNTY
P00205874OtherRAILROAD MEDICARE PIN