Provider Demographics
NPI:1508925553
Name:PALANIAPPAN, MEYYAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEYYAPPAN
Middle Name:
Last Name:PALANIAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 OXEN PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-9453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 PLUM ST
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1277
Practice Address - Country:US
Practice Address - Phone:573-996-2141
Practice Address - Fax:573-996-3949
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209990027Medicaid
025050090Medicare ID - Type Unspecified
MO209990027Medicaid