Provider Demographics
NPI:1922057249
Name:PATEL, BHARATKUMA C (MD)
Entity Type:Individual
Prefix:
First Name:BHARATKUMA
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 1:1070 N STONE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0919
Mailing Address - Country:US
Mailing Address - Phone:386-822-9410
Mailing Address - Fax:386-469-0045
Practice Address - Street 1:1070 N STONE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0919
Practice Address - Country:US
Practice Address - Phone:386-822-9410
Practice Address - Fax:386-469-0045
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
593256803OtherFEI #
FL044545200Medicaid
FL044545200Medicaid
FL044545200Medicaid