Provider Demographics
NPI:1427044064
Name:PATEL, RAVINDRA R (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3972
Mailing Address - Country:US
Mailing Address - Phone:813-933-3324
Mailing Address - Fax:813-932-4357
Practice Address - Street 1:6919 N DALE MABRY HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-933-3324
Practice Address - Fax:813-932-4357
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51003208600000X, 207PE0005X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03993OtherBCBS
020014660OtherRAILROAD MEDICARE
FL046418000Medicaid
D50891Medicare UPIN
FL03993ZMedicare PIN
FL03993XMedicare PIN
FL03993Medicare ID - Type Unspecified