Michael J Palko III, MD

Primary specialty

Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X

License

049863 Issued in GA

Practice address

510 E Oglethorpe Hwy
Hinesville, GA 31313

Phone

(912) 369-7546

Fax

(478) 328-0438

NPI assigned

Nov 15, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Dermatology & Skin Cancer Center, LLC

  • Dermatology Physician
  • Dublin, GA
  • NPI 1063460459

  Dermatopathology

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1093797144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 BELLEVUE RD",
            "address_2": "SUITE 21-A",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212885",
            "telephone_number": "478-275-7202",
            "fax_number": "478-274-8418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E OGLETHORPE HWY",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "31313",
            "telephone_number": "912-369-7546",
            "fax_number": "478-328-0438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALKO",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "049863",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "GA",
            "license": "049863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC4061",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00176683",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000977171C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatopathology (Pathology) Physician in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Dermatopathology (Pathology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.