MEDICARE: CRAIG PALKA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501302362	MI

General Provider Information

NPI Number	:	1336858489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG PALKA DPT

Provider Business Mailing Address
First Line	:	6255 INKSTER RD STE 103
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2145
Country	:	US
Telephone Number	:	734-422-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	04/27/2023

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