Provider Demographics
NPI:1619751500
Name:PALMER, CHRISTOPHER W (TLLP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:W
Last Name:PALMER
Suffix:
Gender:M
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37923 STREAMVIEW DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2549
Mailing Address - Country:US
Mailing Address - Phone:734-497-7188
Mailing Address - Fax:
Practice Address - Street 1:5229 CASS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3930
Practice Address - Country:US
Practice Address - Phone:313-577-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000775390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program