Provider Demographics
NPI:1114951225
Name:PATEL, HIREN K (MD)
Entity Type:Individual
Prefix:
First Name:HIREN
Middle Name:K
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 1:3115 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6729
Mailing Address - Country:US
Mailing Address - Phone:941-258-3635
Mailing Address - Fax:941-258-3630
Practice Address - Street 1:3115 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6729
Practice Address - Country:US
Practice Address - Phone:941-258-3635
Practice Address - Fax:941-258-3630
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77996207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91583Medicare UPIN
46604VMedicare PIN