Provider Demographics
NPI:1619054871
Name:GIRISH PATEL MD PA
Entity Type:Organization
Organization Name:GIRISH PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-821-7111
Mailing Address - Street 1:2112 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3924
Mailing Address - Country:US
Mailing Address - Phone:727-821-7111
Mailing Address - Fax:727-821-7115
Practice Address - Street 1:2112 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:727-821-7111
Practice Address - Fax:727-821-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378469000Medicaid
FLQ0341Medicare PIN
FL378469000Medicaid