1366540502 NPI number — DR. SHIRISKUMAR G PATEL M.D.

Table of content: DR. SHIRISKUMAR G PATEL M.D. (NPI 1366540502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366540502 NPI number — DR. SHIRISKUMAR G PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
SHIRISKUMAR
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366540502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2669 N FLORIDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34442-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-637-2550
Provider Business Mailing Address Fax Number:
352-637-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2669 N. FLORIDA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERNANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-637-2550
Provider Business Practice Location Address Fax Number:
352-637-2551
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME50533 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04517 . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 046201200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN2848 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010060041 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 660089100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 046201200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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