Basic Information
| Provider Information | |||||||||
| NPI: | 1609920768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 NW 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ALEDO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612311317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3095829450 | ||||||||
| FaxNumber: | 3095823735 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 NW 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ALEDO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612311317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3095829450 | ||||||||
| FaxNumber: | 3095823735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036053144 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0006627828 | 01 | IL | BC BS IL PROVIDER NUMBER | OTHER | 036053144 | 05 | IL | MEDICAID | K47031 | 01 | IL | MEDICARE PTAN | OTHER |