1588153043 NPI number — KUNAL PATEL MD

Table of content: KUNAL PATEL MD (NPI 1588153043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588153043 NPI number — KUNAL PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
KUNAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1588153043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 LAKELAND HILLS BLVD
Provider Second Line Business Mailing Address:
ATTN: MANAGED CARE DEPT
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33805-4543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-687-1100
Provider Business Mailing Address Fax Number:
863-630-6528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 LAKELAND HILLS BLVD
Provider Second Line Business Practice Location Address:
PAVILION 1ST FLOOR
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-284-6860
Provider Business Practice Location Address Fax Number:
863-688-7959
Provider Enumeration Date:
05/09/2018

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: 207V00000X , with the licence number:  BP10064219 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME157910 , 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: 679993 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com