Healthcare Provider Details

I. General information

NPI: 1093965501
Provider Name (Legal Business Name): PREMIER HOSPITALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

PO BOX 1047
CROWN POINT IN
46308-1047
US

V. Phone/Fax

Practice location:
  • Phone: 708-288-3452
  • Fax: 708-401-0050
Mailing address:
  • Phone: 708-288-3452
  • Fax: 708-401-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01049154
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01049154
License Number StateIN

VIII. Authorized Official

Name: EMERIC PALMER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 708-288-3452