| Peter A Koretsky Md Pa | |
|
2955 Pineda Plaza Way Ste 115 Melbourne FL 32940-7306 | |
| (321) 254-7375 | |
| (321) 254-7145 |
| Full Name | Peter A Koretsky Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 2955 Pineda Plaza Way Ste 115, Melbourne, Florida |
| Authorized Official Name and Position | Peter A Koretsky (PRESIDENT) |
| Authorized Official Contact | 3212547375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter A Koretsky Md Pa 2955 Pineda Plaza Way Ste 115 Melbourne FL 32940-7306 Ph: (321) 254-7375 | Peter A Koretsky Md Pa 2955 Pineda Plaza Way Ste 115 Melbourne FL 32940-7306 Ph: (321) 254-7375 |
| NPI Number | 1124117791 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 03/28/2014 |
| Medicare PECOS PAC ID | 6406874601 |
|---|---|
| Medicare Enrollment ID | O20051107000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124117791 | NPI | - | NPPES |
| 2734737 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Jill L Polet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861550964 PECOS PAC ID: 7911925946 Enrollment ID: I20051108000378 |
| Provider Name | Peter A Koretsky |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1467556456 PECOS PAC ID: 5597783704 Enrollment ID: I20051108000411 |
| Provider Name | Paige M Ahammer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407073943 PECOS PAC ID: 3476627936 Enrollment ID: I20080731000418 |
| Provider Name | Sarah L Bachand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275314445 PECOS PAC ID: 4981050770 Enrollment ID: I20231031001770 |
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