Provider Demographics
NPI:1114360831
Name:PATEL, PRATIK A (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-255-4003
Mailing Address - Fax:321-255-2728
Practice Address - Street 1:8041 SPYGLASS HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8559
Practice Address - Country:US
Practice Address - Phone:321-255-4003
Practice Address - Fax:321-255-2728
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME115717207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine