Healthcare Provider Details

I. General information

NPI: 1841235322
Provider Name (Legal Business Name): CAMILO H PALACIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E TALL TREE
DERBY KS
67037
US

IV. Provider business mailing address

PO BOX 8035
WICHITA KS
67208-0035
US

V. Phone/Fax

Practice location:
  • Phone: 316-789-8222
  • Fax:
Mailing address:
  • Phone: 316-689-9135
  • Fax: 316-689-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26049
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: