Provider Demographics
NPI:1033557806
Name:PATKA, JAVED FIROZ (DO)
Entity Type:Individual
Prefix:
First Name:JAVED
Middle Name:FIROZ
Last Name:PATKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 MAYMONT PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3158
Mailing Address - Country:US
Mailing Address - Phone:706-294-9785
Mailing Address - Fax:
Practice Address - Street 1:1000 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7315
Practice Address - Country:US
Practice Address - Phone:803-578-8395
Practice Address - Fax:803-578-8376
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-00183208M00000X
FLOS12967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist