Healthcare Provider Details

I. General information

NPI: 1174966378
Provider Name (Legal Business Name): JOHN ANDREW PALSIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HIBISCUS BLVD
MELBOURNE FL
32901-3156
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-5550
  • Fax: 321-728-7553
Mailing address:
  • Phone: 321-361-5550
  • Fax: 321-728-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME140064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: