Provider Demographics
NPI:1265407290
Name:PALCESKI, DIMITRY MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:DIMITRY
Middle Name:MICHAEL
Last Name:PALCESKI
Suffix:
Gender:M
Credentials:DO
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 1210
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34133-1210
Mailing Address - Country:US
Mailing Address - Phone:407-895-8818
Mailing Address - Fax:407-291-3800
Practice Address - Street 1:440 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4206
Practice Address - Country:US
Practice Address - Phone:407-895-8818
Practice Address - Fax:407-291-3800
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9674207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8636YMedicare PIN