Provider Demographics
NPI:1164492864
Name:PATEL, MUKTI B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MUKTI
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:14655 GALAXIE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8575
Mailing Address - Country:US
Mailing Address - Phone:952-432-6161
Mailing Address - Fax:952-432-7019
Practice Address - Street 1:5051 SE 110TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3115
Practice Address - Country:US
Practice Address - Phone:352-245-9157
Practice Address - Fax:352-245-3031
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103092363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292223100Medicaid
FLU5808ZMedicare ID - Type Unspecified
FL292223100Medicaid