Provider Demographics
NPI:1821013608
Name:PATEL, MAHENDRAKUMAR MOHANLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRAKUMAR
Middle Name:MOHANLAL
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 1:2916 W WATERS AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-933-4707
Mailing Address - Fax:813-933-5530
Practice Address - Street 1:2916 W WATERS AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-933-4707
Practice Address - Fax:813-933-5530
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049457700Medicaid
FL07715Medicare ID - Type Unspecified
E21559Medicare UPIN