Provider Demographics
NPI:1528043601
Name:PATHAK, NARESH (MD)
Entity Type:Individual
Prefix:
First Name:NARESH
Middle Name:
Last Name:PATHAK
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 1:7471 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-748-6175
Mailing Address - Fax:954-748-2072
Practice Address - Street 1:7471 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-748-6175
Practice Address - Fax:954-748-2072
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266956100Medicaid
FL08707Medicare ID - Type Unspecified
FL266956100Medicaid