Provider Demographics
NPI:1922149939
Name:CHOKSHI, HARISH M (MD)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:M
Last Name:CHOKSHI
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 1:2120 E. COUNTY ROAD 540A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-644-4094
Mailing Address - Fax:863-644-4294
Practice Address - Street 1:2120 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3740
Practice Address - Country:US
Practice Address - Phone:863-644-4094
Practice Address - Fax:863-644-4294
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23358Medicare ID - Type UnspecifiedMEDICARE #