Provider Demographics
NPI:1679597512
Name:PATEL, RAJNIKANT C (MD)
Entity Type:Individual
Prefix:
First Name:RAJNIKANT
Middle Name:C
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 1:10616 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-2828
Mailing Address - Country:US
Mailing Address - Phone:813-684-3222
Mailing Address - Fax:813-681-8942
Practice Address - Street 1:10616 MAIN ST
Practice Address - Street 2:
Practice Address - City:THONOTOSASSA
Practice Address - State:FL
Practice Address - Zip Code:33592-2828
Practice Address - Country:US
Practice Address - Phone:813-986-1346
Practice Address - Fax:813-986-6642
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0088670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2734311-00Medicaid
FL82684Medicare ID - Type Unspecified
FL2734311-00Medicaid