Active NPI
Michael Palmer, ATL
- Rehabilitation Practitioner
- Roselle, IL
National Provider Identifier
1699825703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 635 Edenwood Dr
Roselle, IL 60172 - Phone
- (630) 539-2826
- Fax
- (630) 539-1288
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
635 Edenwood Dr
Roselle, IL 60172
Mailing address
635 Edenwood Dr
Roselle, IL 60172
Phone (630) 539-2826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02232015 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699825703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 EDENWOOD DR",
"city": "ROSELLE",
"state": "IL",
"postal_code": "60172",
"telephone_number": "630-539-2826",
"fax_number": "630-539-1288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 EDENWOOD DR",
"city": "ROSELLE",
"state": "IL",
"postal_code": "60172",
"telephone_number": "630-539-2826",
"fax_number": "630-539-1288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALMER",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "ATL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "02232015",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roselle, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.