Provider Demographics
NPI:1942259908
Name:PATEL, VIPUL R (MD)
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:R
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 1:380 CELEBRATION PL STE 401
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4606
Mailing Address - Country:US
Mailing Address - Phone:407-303-4673
Mailing Address - Fax:407-303-4674
Practice Address - Street 1:380 CELEBRATION PL STE 401
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4606
Practice Address - Country:US
Practice Address - Phone:407-303-4673
Practice Address - Fax:407-303-4674
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085793208800000X
FLME100187208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44312OtherBCBS
FL280317800Medicaid
FLAL277ZMedicare PIN
FL44312OtherBCBS