Provider Demographics
NPI:1255334959
Name:PATEL, KIRAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:303 NORTH CLYDE MORRIS BL
Mailing Address - Street 2:HALIFAX HEALTH MEDICAL CENTER
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-238-2285
Mailing Address - Fax:386-425-1304
Practice Address - Street 1:303 NORTH CLYDE MORRIS BL
Practice Address - Street 2:HALIFAX HEALTH MEDICAL CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-238-2285
Practice Address - Fax:386-425-1304
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2019-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.37626207Q00000X
FLME88393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1255334959Medicaid
FL275490800Medicaid
FL275490800Medicaid