Provider Demographics
NPI:1629079801
Name:PATEL, PRAKASHKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASHKUMAR
Middle Name:
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 1:38156 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1380
Mailing Address - Country:US
Mailing Address - Phone:813-783-9799
Mailing Address - Fax:813-783-9793
Practice Address - Street 1:38156 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1380
Practice Address - Country:US
Practice Address - Phone:813-783-9799
Practice Address - Fax:813-783-9793
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2021-07-09
Deactivation Date:2006-04-25
Deactivation Code:
Reactivation Date:2006-04-27
Provider Licenses
StateLicense IDTaxonomies
TXT03132084N0400X
FLME861942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267730000Medicaid
FL267730000Medicaid
FL81236ZMedicare PIN