MEDICARE: DR. HARISH M CHOKSHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME63448	FL

General Provider Information

NPI Number	:	1922149939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARISH M CHOKSHI MD

Provider Business Mailing Address
First Line	:	2120 E. COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813
Country	:	US
Telephone Number	:	863-644-4094
Fax Number	:	863-644-4294

Provider Business Practice Location Address
First Line	:	2120 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3740
Country	:	US
Telephone Number	:	863-644-4094
Fax Number	:	863-644-4294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	07/09/2007

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