Provider Demographics
NPI:1750360434
Name:PALMER, TRISH L (MD)
Entity type:Individual
Prefix:DR
First Name:TRISH
Middle Name:L
Last Name:PALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096275207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5647658OtherAETNA ID#
IL036096275 1Medicaid
IL207067OtherMEDICARE PTAN LOCALITY 16
IL207073OtherMEDICARE PTAN LOCALITY 15
ILP00295720OtherRR MEDICARE ID#
IL1633878OtherBCBS GROUP ID#
ILDA4902OtherRR MEDICARE PTAN#
ILK18358Medicare PIN
IL5647658OtherAETNA ID#
IL036096275 1Medicaid