Provider Demographics
NPI:1467556456
Name:KORETSKY, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:KORETSKY
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 1:2955 PINEDA PLAZA WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7306
Mailing Address - Country:US
Mailing Address - Phone:321-254-7375
Mailing Address - Fax:321-254-7145
Practice Address - Street 1:2955 PINEDA PLAZA WAY STE 115
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7306
Practice Address - Country:US
Practice Address - Phone:321-254-7375
Practice Address - Fax:321-254-7145
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53524207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
07029XMedicare ID - Type Unspecified
D45881Medicare UPIN