Provider Demographics
NPI:1669447199
Name:PATEL, AMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
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 1:1032 MAR WALT DR UNIT 230
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6661
Mailing Address - Country:US
Mailing Address - Phone:850-862-3194
Mailing Address - Fax:850-862-4423
Practice Address - Street 1:1032 MAR WALT DR UNIT 230
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6661
Practice Address - Country:US
Practice Address - Phone:850-862-3194
Practice Address - Fax:850-862-4423
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40988208G00000X
PAMD420780174400000X
FLME130524208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101237985Medicaid
PA101237985Medicaid
PA089788FKYMedicare ID - Type Unspecified