Provider Demographics
NPI:1639268196
Name:PALECKI, RICHARD GERARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GERARD
Last Name:PALECKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:LA
Mailing Address - Zip Code:70755-0575
Mailing Address - Country:US
Mailing Address - Phone:225-718-5314
Mailing Address - Fax:225-618-0863
Practice Address - Street 1:230 ROBERTS DR
Practice Address - Street 2:SUITE G
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2661
Practice Address - Country:US
Practice Address - Phone:225-638-6640
Practice Address - Fax:225-618-0863
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD165R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1668842Medicaid
480026913OtherRR MCR
U55468Medicare UPIN
5696630001Medicare NSC
5W407Medicare PIN