MEDICARE: DR. LISA C PALMER D.O.

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	2080P0207X	Pediatric Hematology & Oncology Physician	63183	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972628162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA C PALMER D.O.

Provider Business Mailing Address
First Line	:	2060 BELLEVUE ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5622
Country	:	US
Telephone Number	:	920-965-0606
Fax Number	:	920-965-0607

Provider Business Practice Location Address
First Line	:	2060 BELLEVUE ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5622
Country	:	US
Telephone Number	:	920-965-0606
Fax Number	:	920-965-0607

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	11/24/2014

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