MEDICARE: ANDREW PALMQUIST

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	237700000X	Hearing Instrument Specialist	1851	IL

General Provider Information

NPI Number	:	1386092625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW PALMQUIST

Provider Business Mailing Address
First Line	:	4435 MANCHESTER DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-1655
Country	:	US
Telephone Number	:	815-964-4191
Fax Number	:	815-964-8378

Provider Business Practice Location Address
First Line	:	4435 MANCHESTER DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-1655
Country	:	US
Telephone Number	:	815-964-4191
Fax Number	:	815-964-8378

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

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	09/23/2020

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Directions to “ ANDREW PALMQUIST ” Practice Location

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