Provider Demographics
NPI:1245482439
Name:PATEL, CHIRAG J (MD)
Entity type:Individual
Prefix:
First Name:CHIRAG
Middle Name:J
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 1:6718 LAKE NONA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7984
Mailing Address - Country:US
Mailing Address - Phone:407-857-3937
Mailing Address - Fax:407-392-0420
Practice Address - Street 1:6718 LAKE NONA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7984
Practice Address - Country:US
Practice Address - Phone:407-857-3937
Practice Address - Fax:407-392-0420
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114364AMedicaid
FL14H9BOtherBCBSFL
FL004139800Medicaid
GA003114364AMedicaid