Provider Demographics
NPI:1598866618
Name:BHARGAVA-PATEL, KIRTI (MD)
Entity Type:Individual
Prefix:
First Name:KIRTI
Middle Name:
Last Name:BHARGAVA-PATEL
Suffix:
Gender:F
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:PO BOX 56240
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33732-6240
Mailing Address - Country:US
Mailing Address - Phone:727-895-9200
Mailing Address - Fax:727-895-1199
Practice Address - Street 1:2100 16TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3924
Practice Address - Country:US
Practice Address - Phone:727-895-9200
Practice Address - Fax:727-895-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME071109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263855000Medicaid
FL263855000Medicaid
32131AMedicare ID - Type Unspecified