Provider Demographics
NPI:1134196454
Name:PATEL, MUKESH (MD)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:
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 1:13740 OFFICE PARK CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7145
Mailing Address - Country:US
Mailing Address - Phone:727-863-7487
Mailing Address - Fax:727-861-7504
Practice Address - Street 1:13740 OFFICE PARK CT
Practice Address - Street 2:SUITE A
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7145
Practice Address - Country:US
Practice Address - Phone:727-863-7487
Practice Address - Fax:727-861-7504
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059698207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593458396TOtherBCBS OF ILLINOIS
FL96205OtherFIRST HEALTH
FL4311500OtherAETNA (NON HMO)
FL76705OtherSECURE HORIZON
FL010109800OtherFEDERAL BLACK LUNG
FL0459552OtherAETNA (HMO)
FL101918OtherAVMED
FL10385301OtherCITRUS
FL12222OtherHEALTH OPTIONS (BS FL)
FL40302OtherFOUNDATION HEALTH
FL4805031OtherUHC
FL593458396OtherHUMANA
FL630OtherBAYCARE
FL0762475OtherCIGNA
FL12222OtherBCBS OF FL
FL2900271OtherGHI
FL00222OtherWELLCARE
FL054818900Medicaid
FL01895OtherUNIVERSAL
FL7V9301OtherEMPIRE BC/BS
FL40302OtherFOUNDATION HEALTH
FL593458396TOtherBCBS OF ILLINOIS