Provider Demographics
NPI:1417299454
Name:CHIRAG BAKULESH PATEL MD PA
Entity Type:Organization
Organization Name:CHIRAG BAKULESH PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-219-4857
Mailing Address - Street 1:1519 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-1706
Mailing Address - Country:US
Mailing Address - Phone:848-219-4857
Mailing Address - Fax:866-696-1224
Practice Address - Street 1:295 PATTERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6247
Practice Address - Country:US
Practice Address - Phone:863-422-4338
Practice Address - Fax:866-696-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-16
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98613207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280991500Medicaid
FL280991500Medicaid