Healthcare Provider Details

I. General information

NPI: 1245215060
Provider Name (Legal Business Name): DAVID J PALMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID J PALMER MD

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1520
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

1630 SHERMAN AVE
EVANSTON IL
60201-3711
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax: 312-695-3652
Mailing address:
  • Phone: 847-535-6440
  • Fax: 224-271-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number036062843
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036062843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: