Provider Demographics
NPI:1679131866
Name:SETHI, KAMALDEEP (MD)
Entity type:Individual
Prefix:
First Name:KAMALDEEP
Middle Name:
Last Name:SETHI
Suffix:
Gender:
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:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:950 MARSH LANDING PKWY STE 105B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-1408
Practice Address - Country:US
Practice Address - Phone:904-376-4900
Practice Address - Fax:904-390-7546
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT217375207Q00000X
FLME169822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine