Provider Demographics
NPI:1275199952
Name:PALM, JULIAN RODGER
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:RODGER
Last Name:PALM
Suffix:
Gender:M
Credentials:
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 339662
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9662
Mailing Address - Country:US
Mailing Address - Phone:313-595-7712
Mailing Address - Fax:
Practice Address - Street 1:32273 TALL TIMBER DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1768
Practice Address - Country:US
Practice Address - Phone:313-595-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty