Provider Demographics
NPI:1083657951
Name:PATEL, KIRIT A (MD)
Entity Type:Individual
Prefix:MR
First Name:KIRIT
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15659
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-5659
Mailing Address - Country:US
Mailing Address - Phone:727-793-9300
Mailing Address - Fax:727-712-4688
Practice Address - Street 1:951 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2163
Practice Address - Country:US
Practice Address - Phone:321-268-6333
Practice Address - Fax:216-831-2425
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0575132085R0202X
FLME972362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723748Medicaid
FL92394OtherBCBS OF FL
FL277329500Medicaid
OH0723748Medicaid
FL277329500Medicaid
E60101Medicare UPIN
OHPA0660917Medicare ID - Type Unspecified