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General NPI Number Information
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NPI Number | 1508085341
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Entity Type | Organization
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Legal Business Name | MICHAEL J PALCHAK
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 25133 COUNTY ROAD 96
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City | DAVIS
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State | CA
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Zip | 95616-9476
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Country | US
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Telephone | 530-759-9280
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Fax | 530-758-6904
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Provider Business Mailing Address
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Address Line | 25133 COUNTY ROAD 96
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City | DAVIS
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State | CA
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Zip | 95616-9476
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Country | US
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Telephone | 530-758-6974
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Fax | 530-758-6904
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JOSEPH PALCHAK
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Credential | MD
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Telephone | 530-758-6974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G63751
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License Number State | CA
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