Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | OS9674 | FL |
NPI | 1265407290 |
---|---|
Provider Name | Dr. Dimitry Michael Palceski |
First Address | Bonita Springs, FL 34133-1210 |
Second Address | Winter Park, FL 32789-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 27/12/2019 |