Healthcare Provider Details

I. General information

NPI: 1619478229
Provider Name (Legal Business Name): ALEKSANDER W PECHEREK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S HARBOR CITY BLVD STE 110
MELBOURNE FL
32901-1906
US

IV. Provider business mailing address

709 S HARBOR CITY BLVD STE 110
MELBOURNE FL
32901-1906
US

V. Phone/Fax

Practice location:
  • Phone: 321-499-4646
  • Fax: 321-270-9449
Mailing address:
  • Phone: 321-499-4646
  • Fax: 321-270-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036167636
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: