Basic Information
| Provider Information | |||||||||
| NPI: | 1265846372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44250 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483141002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489640400 | ||||||||
| FaxNumber: | 2489640401 | ||||||||
| Practice Location | |||||||||
| Address1: | 744 MIDDLE CREEK RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | SEVIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378625036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654469500 | ||||||||
| FaxNumber: | 8654469501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301105449 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | Q029018 | 05 | TN | MEDICAID |