Provider Demographics
NPI:1326439142
Name:ASHWINKUMAR R PATEL
Entity Type:Organization
Organization Name:ASHWINKUMAR R PATEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHWINKUMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-328-1575
Mailing Address - Street 1:1403 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1000
Mailing Address - Country:US
Mailing Address - Phone:407-328-1575
Mailing Address - Fax:407-328-1577
Practice Address - Street 1:1403 MEDICAL PLAZA DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1085
Practice Address - Country:US
Practice Address - Phone:407-328-1575
Practice Address - Fax:407-328-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE79895Medicare UPIN