Provider Demographics
NPI:1396962627
Name:PALMER, KEVIN KOLOSEUS (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KOLOSEUS
Last Name:PALMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N
Mailing Address - Street 2:300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2231
Mailing Address - Country:US
Mailing Address - Phone:561-488-2200
Mailing Address - Fax:561-488-1064
Practice Address - Street 1:9970 CENTRAL PARK BLVD N
Practice Address - Street 2:300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2231
Practice Address - Country:US
Practice Address - Phone:561-488-2200
Practice Address - Fax:561-488-1064
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340647400Medicaid
FL340647400Medicaid