Provider Demographics
NPI:1417043399
Name:PALMEN CENTER FOR PSYCHIATRY AND PSYCHOTHERAPY
Entity Type:Organization
Organization Name:PALMEN CENTER FOR PSYCHIATRY AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-269-6992
Mailing Address - Street 1:PO BOX 7415
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55903
Mailing Address - Country:US
Mailing Address - Phone:507-269-6992
Mailing Address - Fax:507-282-1735
Practice Address - Street 1:20 2ND AVE SW
Practice Address - Street 2:STE M114
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902
Practice Address - Country:US
Practice Address - Phone:507-269-6992
Practice Address - Fax:507-282-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN264502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04060Medicare PIN