Provider Demographics
NPI:1477663003
Name:PATEL, PALLAVI K (MD)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 152557
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2557
Mailing Address - Country:US
Mailing Address - Phone:813-239-3262
Mailing Address - Fax:813-237-6941
Practice Address - Street 1:7108 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4915
Practice Address - Country:US
Practice Address - Phone:813-239-3262
Practice Address - Fax:813-237-6941
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039612207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052602906Medicaid