Provider Demographics
NPI:1255329504
Name:KOSHI, ELIZABETH PALACHICACKA (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PALACHICACKA
Last Name:KOSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 GOLFVIEW AVE
Mailing Address - Street 2:4TH FLOOR ATTN: BILLING DEPARTMENT
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6738
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:863-519-7696
Practice Address - Street 1:1805 HOBBS RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4644
Practice Address - Country:US
Practice Address - Phone:863-965-5400
Practice Address - Fax:863-965-3739
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME209029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069749400Medicaid
FL53706XMedicare PIN
FL069749400Medicaid