Healthcare Provider Details

I. General information

NPI: 1053373274
Provider Name (Legal Business Name): JEFFREY M PALACIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 W COLONIAL PKWY
INVERNESS IL
60067-4725
US

IV. Provider business mailing address

351 DUBLIN RD
BLOOMINGDALE IL
60108-3514
US

V. Phone/Fax

Practice location:
  • Phone: 847-749-0514
  • Fax: 847-221-8040
Mailing address:
  • Phone: 617-775-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number213034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: