1043537335 NPI number — MILAN RAVINDRA PATEL M.D.

Table of content: MILAN RAVINDRA PATEL M.D. (NPI 1043537335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043537335 NPI number — MILAN RAVINDRA PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MILAN
Provider Middle Name:
RAVINDRA
Provider Name Prefix Text:
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:
1043537335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 EXECUTIVE DR STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-5323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-347-0005
Provider Business Mailing Address Fax Number:
727-541-6558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33920 US 19 N STE 124
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34684-2619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-785-7654
Provider Business Practice Location Address Fax Number:
727-787-0061
Provider Enumeration Date:
04/26/2010

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: 207RG0100X , with the licence number:  ME135922 , 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: 103311400 . 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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