Provider Demographics
NPI:1316970338
Name:PALCHAK, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PALCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25133 COUNTY ROAD 96
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9476
Mailing Address - Country:US
Mailing Address - Phone:530-758-6974
Mailing Address - Fax:530-758-6904
Practice Address - Street 1:25133 COUNTY ROAD 96
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9476
Practice Address - Country:US
Practice Address - Phone:530-979-7775
Practice Address - Fax:530-758-6904
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63751207P00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G637510Medicaid
F08188Medicare UPIN
CA00G637510Medicaid
CA00G637513Medicare PIN