MEDICARE: DOUGLAS A. PALENSCHAT M.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	38036	CO

General Provider Information

NPI Number	:	1679518773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS A. PALENSCHAT M.D,

Provider Business Mailing Address
First Line	:	1128 CASEY SPRINGS CIR
Second Line	:
City	:	IUKA
State	:	MS
Zip	:	38852-2516
Country	:	US
Telephone Number	:	662-423-9162
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 CASEY SPRINGS CIR
Second Line	:
City	:	IUKA
State	:	MS
Zip	:	38852-2516
Country	:	US
Telephone Number	:	662-423-9162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	11/24/2008

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