Healthcare Provider Details

I. General information

NPI: 1518145739
Provider Name (Legal Business Name): MS. RITA LOUISE PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 COYLE ST
DETROIT MI
48228-2451
US

IV. Provider business mailing address

PO BOX 4128
DETROIT MI
48204-0128
US

V. Phone/Fax

Practice location:
  • Phone: 313-605-0555
  • Fax: 313-846-6889
Mailing address:
  • Phone: 313-605-0555
  • Fax: 313-846-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberP456738549356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: