Provider Demographics
NPI:1699825703
Name:PALMER, MICHAEL (ATL)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:ATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 EDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172
Mailing Address - Country:US
Mailing Address - Phone:630-539-2826
Mailing Address - Fax:630-539-1288
Practice Address - Street 1:635 EDENWOOD DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172
Practice Address - Country:US
Practice Address - Phone:630-539-2826
Practice Address - Fax:630-539-1288
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232015OtherBCBS