Provider Demographics
NPI:1578603668
Name:PALMER, HENRY R (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:R
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3048 N WILTON AVE
Mailing Address - Street 2:2ND
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6710
Mailing Address - Country:US
Mailing Address - Phone:773-296-5424
Mailing Address - Fax:773-296-5280
Practice Address - Street 1:3048 N WILTON AVE
Practice Address - Street 2:2ND
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6710
Practice Address - Country:US
Practice Address - Phone:773-296-5424
Practice Address - Fax:773-296-5280
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2012-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036052930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052930Medicaid
IL036052930Medicaid
IL209076Medicare PIN