1891878146 NPI number — DR. MITEN R PATEL M.D.

Table of content: DR. MITEN R PATEL M.D. (NPI 1891878146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891878146 NPI number — DR. MITEN R PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MITEN
Provider Middle Name:
R
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:
1891878146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7015 AC SKINNER PARKWAY
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-363-2113
Provider Business Mailing Address Fax Number:
904-538-3672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7015 AC SKINNER PARKWAY
Provider Second Line Business Practice Location Address:
BUILDING 100
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FLORIDA
Provider Business Practice Location Address Postal Code:
32256-6932
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
904-516-3737
Provider Business Practice Location Address Fax Number:
904-516-3738
Provider Enumeration Date:
10/23/2006

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: 207RH0003X , with the licence number:  ME 90833 , 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: 278118200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 936005403B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7210893 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 95177 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 307581 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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