Healthcare Provider Details

I. General information

NPI: 1154318046
Provider Name (Legal Business Name): JAIDEEP HOSKOTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAIDEEP H CHAKRAPANI MD

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CYPRESS EDGE DR STE 208
PALM COAST FL
32164-8454
US

IV. Provider business mailing address

120 CYPRESS EDGE DR STE 208
PALM COAST FL
32164-8454
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-4460
  • Fax: 386-586-4461
Mailing address:
  • Phone: 386-586-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME87751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: