Healthcare Provider Details

I. General information

NPI: 1689721482
Provider Name (Legal Business Name): KEVIN TERRENCE PALKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 HOSPITAL DR
HANNIBAL MO
63401-6890
US

IV. Provider business mailing address

PO BOX 1239
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-3331
  • Fax: 573-629-3336
Mailing address:
  • Phone: 573-629-3469
  • Fax: 573-629-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036109545
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2015008493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: