Provider Demographics
NPI:1467437004
Name:PATEL, BHASKERRAO P (MD)
Entity Type:Individual
Prefix:
First Name:BHASKERRAO
Middle Name:P
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 MALABAR RD STE A
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950
Practice Address - Country:US
Practice Address - Phone:321-312-3464
Practice Address - Fax:321-409-6811
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045948800Medicaid
FLP01164173OtherHF RR MEDICARE
FL110078600OtherRR MEDICARE
FL03735YOtherFL MEDICARE