Provider Demographics
NPI:1649912833
Name:PALM, ANTHONY DANIEL
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DANIEL
Last Name:PALM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30512 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1548
Mailing Address - Country:US
Mailing Address - Phone:586-944-6130
Mailing Address - Fax:
Practice Address - Street 1:30512 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1548
Practice Address - Country:US
Practice Address - Phone:586-944-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program