Provider Demographics
NPI:1790893535
Name:PATEL, RAHUL (M D)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12989 SOUTHERN BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9211
Mailing Address - Country:US
Mailing Address - Phone:561-791-2500
Mailing Address - Fax:561-791-2535
Practice Address - Street 1:12989 SOUTHERN BLVD
Practice Address - Street 2:STE 204
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9211
Practice Address - Country:US
Practice Address - Phone:561-791-2500
Practice Address - Fax:561-791-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262658600Medicaid
FLG35415Medicare UPIN
FLE3910WMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID
FLK4999Medicare ID - Type UnspecifiedGROUP PROVIDER ID