Healthcare Provider Details

I. General information

NPI: 1053313080
Provider Name (Legal Business Name): ELIZABETH FISHER PALLANTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 PARK ST SUITE 101
MUSKEGON MI
49444-3736
US

IV. Provider business mailing address

766 OAKMERE PL
NORTH MUSKEGON MI
49445-2874
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-0411
  • Fax: 231-739-8502
Mailing address:
  • Phone: 231-719-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301051402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: