Provider Demographics
NPI:1811935208
Name:PALESTINE, MICHAEL DANE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANE
Last Name:PALESTINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2334 WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5945
Mailing Address - Country:US
Mailing Address - Phone:505-984-8610
Mailing Address - Fax:505-984-0127
Practice Address - Street 1:649 HARKLE RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4765
Practice Address - Country:US
Practice Address - Phone:505-989-8200
Practice Address - Fax:505-989-8131
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2013-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM9996207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71946Medicaid
NM71946Medicaid
NM320129917Medicare UPIN