Provider Demographics
NPI:1689355190
Name:PALMER, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 GUNDERSEN DR STE A
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2403
Mailing Address - Country:US
Mailing Address - Phone:630-871-2100
Mailing Address - Fax:630-588-0824
Practice Address - Street 1:336 GUNDERSEN DR STE A
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2403
Practice Address - Country:US
Practice Address - Phone:630-871-2100
Practice Address - Fax:630-588-0824
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program