Provider Demographics
NPI:1083861017
Name:PATEL, TEJAS B (MD)
Entity Type:Individual
Prefix:
First Name:TEJAS
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 1:1403 MEDICAL PLAZA DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 106
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1085
Practice Address - Country:US
Practice Address - Phone:407-328-1575
Practice Address - Fax:407-328-1577
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-121652207R00000X
WI52033-20207R00000X
FLME109969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPV681OtherHF MA
FL005933900Medicaid
FLME109969OtherMEDICAL LICENSE
WI014354275Medicare PIN