Provider Demographics
NPI:1083693568
Name:PATEL, CHANDRAKANT B (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRAKANT
Middle Name:B
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 1:4639 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2177
Mailing Address - Country:US
Mailing Address - Phone:863-471-1010
Mailing Address - Fax:863-382-3398
Practice Address - Street 1:4639 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2177
Practice Address - Country:US
Practice Address - Phone:863-471-1010
Practice Address - Fax:863-382-3398
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049560207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045968200Medicaid
FL045968200Medicaid
FL02604YMedicare ID - Type Unspecified