Provider Demographics
NPI:1942401021
Name:PALMER, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OGDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7222
Mailing Address - Country:US
Mailing Address - Phone:630-898-4515
Mailing Address - Fax:630-879-6805
Practice Address - Street 1:2000 OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7222
Practice Address - Country:US
Practice Address - Phone:630-898-4515
Practice Address - Fax:630-978-6805
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9158390200000X
IA384002085R0202X
IL0361232542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-123254Medicaid
ILP00873562Medicare PIN
IL036-123254Medicaid
IL244340001Medicare PIN
IAP00761016Medicare PIN