Provider Demographics
NPI:1508006610
Name:PATEL, MUKESHKUMAR ISHWARBHAI (MD)
Entity Type:Individual
Prefix:
First Name:MUKESHKUMAR
Middle Name:ISHWARBHAI
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 1:11373 CORTEZ BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5414
Mailing Address - Country:US
Mailing Address - Phone:706-814-3101
Mailing Address - Fax:
Practice Address - Street 1:13906 LAKESHORE BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1487
Practice Address - Country:US
Practice Address - Phone:727-863-7000
Practice Address - Fax:727-863-7007
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116470207R00000X
GA63113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine