Provider Demographics
NPI:1659539054
Name:PATEL, GHANSHYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GHANSHYAM
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 1:13003 TERRACE BROOK PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-3009
Mailing Address - Country:US
Mailing Address - Phone:813-454-2408
Mailing Address - Fax:
Practice Address - Street 1:2734 WINDGUARD CIR
Practice Address - Street 2:102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7362
Practice Address - Country:US
Practice Address - Phone:813-929-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0041055207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067630600Medicaid
FLD54033Medicare UPIN