Provider Demographics
NPI:1891813085
Name:PALATNIK MEDICAL CORPORATION
Entity type:Organization
Organization Name:PALATNIK MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALATNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-334-1100
Mailing Address - Street 1:701 HOWE AVENUE
Mailing Address - Street 2:STE C5
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-972-1115
Mailing Address - Fax:916-303-7408
Practice Address - Street 1:701 HOWE AVE
Practice Address - Street 2:STE C5
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4670
Practice Address - Country:US
Practice Address - Phone:916-972-1115
Practice Address - Fax:916-303-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51374261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01415Medicaid
CAZZZ27543ZOtherMEDICARE GROUP
CA00C513740Medicare PIN
CAY01211Medicare UPIN