Healthcare Provider Details

I. General information

NPI: 1265697783
Provider Name (Legal Business Name): SETH CHARLES PALMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N. WELLNESS DR
HOLLAND MI
49424
US

IV. Provider business mailing address

3100 N. WELLNESS DR
HOLLAND MI
49424
US

V. Phone/Fax

Practice location:
  • Phone: 616-994-2770
  • Fax: 616-920-6533
Mailing address:
  • Phone: 616-994-2770
  • Fax: 616-920-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101017138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: