Provider Demographics
NPI:1336319466
Name:PATEL, DIVYA CHANDRAKANT (DO)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:CHANDRAKANT
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # M452
Mailing Address - Street 2:P.O BOX 100225
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0225
Mailing Address - Country:US
Mailing Address - Phone:352-273-9199
Mailing Address - Fax:352-273-9154
Practice Address - Street 1:1600 SW ARCHER RD # M452
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0225
Practice Address - Country:US
Practice Address - Phone:352-273-9199
Practice Address - Fax:352-273-9154
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.002428207RP1001X, 207RC0200X
FLOS12851207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012993500Medicaid
FL012993500Medicaid