Provider Demographics
NPI:1396742169
Name:PAREKH, DIPAKKUMAR MAHASUKHRAI (MD)
Entity type:Individual
Prefix:
First Name:DIPAKKUMAR
Middle Name:MAHASUKHRAI
Last Name:PAREKH
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 1:14690 SPRING HILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:11915 OAK TRAIL WAY
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668
Practice Address - Country:US
Practice Address - Phone:727-863-7995
Practice Address - Fax:727-867-4359
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2019-02-14
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
FLME42977207RI0011X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102948OtherAVMED
FL202205OtherAMERI-GROUP
FL049408900Medicaid
FL5694313OtherAETNA
FL202205OtherAMERI-GROUP
FLD84913Medicare UPIN
FL049408900Medicaid