Healthcare Provider Details

I. General information

NPI: 1477798056
Provider Name (Legal Business Name): DAVID BURKE PALKOVIC H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 MOUNT DE CHANTAL RD
WHEELING WV
26003-6357
US

IV. Provider business mailing address

1311 MOUNT DE CHANTAL RD
WHEELING WV
26003-6357
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-0777
  • Fax: 304-242-0977
Mailing address:
  • Phone: 304-242-0777
  • Fax: 304-242-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number885
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2672
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: