Provider Demographics
NPI:1467469700
Name:PATEL, BHADRESH I (MD)
Entity Type:Individual
Prefix:
First Name:BHADRESH
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:802 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127
Mailing Address - Country:US
Mailing Address - Phone:386-788-9086
Mailing Address - Fax:386-788-6589
Practice Address - Street 1:802 DUNLAWTON AVE
Practice Address - Street 2:STE 101
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-788-9086
Practice Address - Fax:386-788-6589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0068922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5363010OtherAETNA
FL080137788OtherRAILROAD MEDICARE
FL5031818-012OtherCIGNA
FL01-00873OtherUHC
FL27612OtherBLUE CROSS BLUE SHIELD
FL379467900Medicaid
FL6009354OtherGHI
FL6009354OtherGHI
FL27612ZMedicare PIN