Provider Demographics
NPI:1134499726
Name:KAPILA M PATEL M D P A
Entity Type:Organization
Organization Name:KAPILA M PATEL M D P A
Other - Org Name:KAPILA M PATEL M D P A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAPILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:863-688-7100
Mailing Address - Street 1:1500 LAKELAND HILLA BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3257
Mailing Address - Country:US
Mailing Address - Phone:863-688-7100
Mailing Address - Fax:
Practice Address - Street 1:1500 LAKELAND HILLA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3257
Practice Address - Country:US
Practice Address - Phone:863-688-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAPILA M PATEL M D P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 33656261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53604Medicare PIN
FL66496Medicare UPIN