Provider Demographics
NPI:1437183837
Name:PATEL, DILIPKUMAR R
Entity Type:Individual
Prefix:
First Name:DILIPKUMAR
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PARK PLACE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2373
Mailing Address - Country:US
Mailing Address - Phone:407-933-2255
Mailing Address - Fax:407-932-0072
Practice Address - Street 1:207 PARK PLACE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2373
Practice Address - Country:US
Practice Address - Phone:407-933-2255
Practice Address - Fax:407-932-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0039611174400000X
FLME39611208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047443600Medicaid
FL49050ZMedicare PIN
FL047443600Medicaid