Basic Information
| Provider Information | |||||||||
| NPI: | 1417113747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHN-PALMA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1675 LEAHY ST STE 315A | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494425543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317275250 | ||||||||
| FaxNumber: | 2317275248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1675 LEAHY ST STE 315A | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494425543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317275250 | ||||||||
| FaxNumber: | 2317275248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2008 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101017998 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100027651 | 05 | WI | MEDICAID |