Provider Demographics
NPI:1588910343
Name:LALCHETA, PARESH (MD)
Entity type:Individual
Prefix:DR
First Name:PARESH
Middle Name:
Last Name:LALCHETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PARESHKUMAR
Other - Middle Name:PRABHUDAS
Other - Last Name:LALCHETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12620 BEACH BLVD
Mailing Address - Street 2:SUITE 3-155
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7131
Mailing Address - Country:US
Mailing Address - Phone:904-222-6176
Mailing Address - Fax:904-425-7857
Practice Address - Street 1:6885 BELFORT OAKS PL
Practice Address - Street 2:STE 230
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6283
Practice Address - Country:US
Practice Address - Phone:904-222-6176
Practice Address - Fax:904-425-7857
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09137600207R00000X
FLME 113439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006690400Medicaid
FLGL174XMedicare PIN