Provider Demographics
NPI:1629496484
Name:PATEL, AGAM
Entity Type:Individual
Prefix:
First Name:AGAM
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 CRESTOVER LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6470
Mailing Address - Country:US
Mailing Address - Phone:813-563-0917
Mailing Address - Fax:727-220-5918
Practice Address - Street 1:2344 CRESTOVER LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6470
Practice Address - Country:US
Practice Address - Phone:813-563-0917
Practice Address - Fax:727-220-5918
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151100207RC0000X, 207RI0011X
CODR.0072051207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program