Provider Demographics
NPI:1932126083
Name:PAREKH, KAMLESH
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:
Last Name:PAREKH
Suffix:
Gender:M
Credentials:
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 247
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-0247
Mailing Address - Country:US
Mailing Address - Phone:662-562-8278
Mailing Address - Fax:662-562-8279
Practice Address - Street 1:300 E MAIN STREET PLZ
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2227
Practice Address - Country:US
Practice Address - Phone:662-562-8278
Practice Address - Fax:662-562-8279
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114201Medicaid
MS110000685Medicare PIN
MS00114201Medicaid