Provider Demographics
NPI:1609920768
Name:PALMER, DENNIS D (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:D
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 1:1007 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1317
Mailing Address - Country:US
Mailing Address - Phone:309-582-9450
Mailing Address - Fax:309-582-3735
Practice Address - Street 1:1007 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1317
Practice Address - Country:US
Practice Address - Phone:309-582-9450
Practice Address - Fax:309-582-3735
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006627828OtherBC BS IL PROVIDER NUMBER
IL036053144Medicaid
ILK47031OtherMEDICARE PTAN
ILDO9807Medicare UPIN