Provider Demographics
NPI:1881687747
Name:PATEL, AJAY PRAVIN (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:PRAVIN
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 1:6919 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3972
Mailing Address - Country:US
Mailing Address - Phone:813-933-3324
Mailing Address - Fax:813-932-4357
Practice Address - Street 1:6919 N DALE MABRY HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-933-3324
Practice Address - Fax:813-932-4357
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94121207PE0005X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269125OtherWELLCARE
P00276279OtherRAILROAD MEDICARE
FL29980OtherBCBS
FL273800700Medicaid
FLU6036ZMedicare PIN
FL29980OtherBCBS