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General NPI Number Information
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NPI Number | 1902241524
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Entity Type | Organization
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Legal Business Name | M K PALMORE MD SC
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 3641 E 108TH ST
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City | CHICAGO
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State | IL
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Zip | 60617-6951
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Country | US
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Telephone | 773-731-5466
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Fax | 773-731-5461
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Provider Business Mailing Address
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Address Line | PO BOX 5543
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City | CHICAGO
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State | IL
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Zip | 60680-5543
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Country | US
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Telephone | 773-731-5466
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Fax | 773-731-6451
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Authorized Official
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Title or Position | OWNER
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Name | MARY K PALMORE
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Credential | MD
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Telephone | 773-731-5466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036061973
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License Number State | IL
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