Provider Demographics
NPI:1407004708
Name:PATEL, PAVANKUMAR (MD)
Entity type:Individual
Prefix:
First Name:PAVANKUMAR
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:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-253-2900
Mailing Address - Fax:321-435-0100
Practice Address - Street 1:5200 BABCOCK ST NE STE 106A
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4639
Practice Address - Country:US
Practice Address - Phone:321-373-7700
Practice Address - Fax:321-256-5512
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449832208M00000X, 207R00000X
IN01069508A207R00000X
FLME166782207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102882048Medicaid
IN201021830Medicaid
IN201021830Medicaid
INP01037136Medicare PIN
PA355561Medicare PIN