Healthcare Provider Details

I. General information

NPI: 1194040980
Provider Name (Legal Business Name): PANKIT TUSHAR PARIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15496 MAX LEGGETT PKWY
JACKSONVILLE FL
32218-2564
US

IV. Provider business mailing address

15496 MAX LEGGETT PKWY
JACKSONVILLE FL
32218-2564
US

V. Phone/Fax

Practice location:
  • Phone: 904-895-5400
  • Fax: 904-895-5401
Mailing address:
  • Phone: 904-895-5400
  • Fax: 904-895-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME128791
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME128791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: