Healthcare Provider Details

I. General information

NPI: 1275846495
Provider Name (Legal Business Name): DILIP PARULEKAR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S HOSPITAL DR
FULTON MO
65251-2510
US

IV. Provider business mailing address

20 S HOSPITAL DR
FULTON MO
65251-2510
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-8505
  • Fax: 573-642-5091
Mailing address:
  • Phone: 573-642-8505
  • Fax: 573-642-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35343
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35343
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000009816
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMEDICARE
# 2
Identifier200960409
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: DR. DILIP GANPAT PARULEKAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 573-642-8505