Provider Demographics
NPI:1396731709
Name:PALUMBO, ANNE L (DO)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11905 56TH ST W
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-4434
Mailing Address - Country:US
Mailing Address - Phone:563-271-4846
Mailing Address - Fax:
Practice Address - Street 1:913 NW GARDEN VALLY BLVD
Practice Address - Street 2:ROSEBURG VA HEALTHCARE SYSTEM
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-440-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3368207RI0200X
IL036101964207RI0200X
PAOS008197L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA01A1OtherJOHN DEERE EDI#
IA0418517Medicaid
G19598OtherUPIN
084958OtherHEALTH ALLIANCE
IA13403OtherBC/BS OF IA
IL8122859OtherIL BC/BS
IL036101964Medicaid
IA1305894OtherCONTROLLED SUBSTANCE#
BP3724122OtherFEDERAL DEA#
IL036101964Medicaid
BP3724122OtherFEDERAL DEA#