Healthcare Provider Details

I. General information

NPI: 1932126083
Provider Name (Legal Business Name): KAMLESH PAREKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN STREET PLZ
SENATOBIA MS
38668-2227
US

IV. Provider business mailing address

PO BOX 247
HERNANDO MS
38632-0247
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-8278
  • Fax: 662-562-8279
Mailing address:
  • Phone: 662-562-8278
  • Fax: 662-562-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14012
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: