1134196454 NPI number — DR. MUKESH PATEL M.D.

Table of content: DR. MUKESH PATEL M.D. (NPI 1134196454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134196454 NPI number — DR. MUKESH PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MUKESH
Provider Middle Name:
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:
1134196454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13740 OFFICE PARK CT
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667-7145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-863-7487
Provider Business Mailing Address Fax Number:
727-861-7504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13740 OFFICE PARK CT
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667-7145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-863-7487
Provider Business Practice Location Address Fax Number:
727-861-7504
Provider Enumeration Date:
03/06/2006

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: 207RC0200X , with the licence number:  ME0059698 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: ME0059698 , 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: 593458396T . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 96205 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4311500 . This is a "AETNA (NON HMO)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 76705 . This is a "SECURE HORIZON" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010109800 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0459552 . This is a "AETNA (HMO)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101918 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10385301 . This is a "CITRUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12222 . This is a "HEALTH OPTIONS (BS FL)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 40302 . This is a "FOUNDATION HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4805031 . This is a "UHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593458396 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 630 . This is a "BAYCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0762475 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12222 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2900271 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00222 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 054818900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01895 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7V9301 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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