Provider Demographics
NPI:1427072263
Name:PALMER, RUSSELL B (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:B
Last Name:PALMER
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 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-6818
Mailing Address - Fax:317-621-1179
Practice Address - Street 1:11911 N MERIDIAN STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6919
Practice Address - Country:US
Practice Address - Phone:317-621-1151
Practice Address - Fax:317-621-1179
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045376A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200098950Medicaid
IN000000313333OtherANTHEM
INP01291601OtherRAILROAD MEDICARE
IN214440DMedicare PIN
INP01291601OtherRAILROAD MEDICARE
IN200098950Medicaid