Provider Demographics
NPI:1821155029
Name:LECHELER, FRED A (DPMPA)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:A
Last Name:LECHELER
Suffix:
Gender:M
Credentials:DPMPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 NORTH CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-7316
Mailing Address - Country:US
Mailing Address - Phone:386-427-4020
Mailing Address - Fax:386-427-0451
Practice Address - Street 1:445 NORTH CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-7316
Practice Address - Country:US
Practice Address - Phone:386-427-4020
Practice Address - Fax:386-427-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2782213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00226965OtherMEDICARE RAILROAD
FLP00226965OtherMEDICARE RAILROAD
FLU71453Medicare UPIN
FL5695470001Medicare NSC
E3933Medicare PIN
52-2447011OtherEIN NUMBER