Healthcare Provider Details

I. General information

NPI: 1174029284
Provider Name (Legal Business Name): MARCO PALOMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 SOUTH MARTIN LUTHER KING DRIVE
CHICAGO IL
60616
US

IV. Provider business mailing address

28594 NETWORK PL
CHICAGO IL
60673-1285
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-7117
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.157428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: