=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417043399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALMEN CENTER FOR PSYCHIATRY AND PSYCHOTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 10/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 2ND AVE SW STE M114
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-269-6992
-----------------------------------------------------
Fax | 507-282-1735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7415
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-269-6992
-----------------------------------------------------
Fax | 507-282-1735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | MICHAEL A PALMEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 507-269-6992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 26450
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------