Provider Demographics
NPI:1417908013
Name:PAREKATTIL, SIJO JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:SIJO
Middle Name:JOSEPH
Last Name:PAREKATTIL
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 1:2341 GOLDEN ASTER ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6359
Mailing Address - Country:US
Mailing Address - Phone:863-258-4999
Mailing Address - Fax:407-650-2724
Practice Address - Street 1:15548 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9556
Practice Address - Country:US
Practice Address - Phone:407-547-1654
Practice Address - Fax:407-650-2724
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92021208800000X
FLFLME0092021208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME92021OtherMEDICAL LICENSE
FL272132500Medicaid
FLME92021OtherMEDICAL LICENSE
FL03568ZMedicare ID - Type Unspecified