Provider Demographics
NPI:1629381652
Name:PATEL, DIPALI S
Entity Type:Individual
Prefix:DR
First Name:DIPALI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 W SWANN AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2417
Mailing Address - Country:US
Mailing Address - Phone:813-254-8055
Mailing Address - Fax:813-443-8163
Practice Address - Street 1:1919 W SWANN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2404
Practice Address - Country:US
Practice Address - Phone:813-254-8055
Practice Address - Fax:813-443-8163
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08792800207Q00000X
FLME109273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004115800Medicaid
FLFK821XMedicare PIN