Provider Demographics
NPI:1245593987
Name:PATEL, PRAKRUT (MD)
Entity type:Individual
Prefix:
First Name:PRAKRUT
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 BUDINGER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4123
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-891-2941
Practice Address - Street 1:1330 BUDINGER AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4123
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:407-891-2941
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME136480207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103581400Medicaid