Provider Demographics
NPI:1093818460
Name:PATEL, HARISH J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:J
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 1:5444 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3360
Mailing Address - Country:US
Mailing Address - Phone:727-528-2272
Mailing Address - Fax:727-528-1437
Practice Address - Street 1:5444 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3360
Practice Address - Country:US
Practice Address - Phone:727-528-2272
Practice Address - Fax:727-528-1437
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370724501Medicaid
FLE97526Medicare UPIN