Provider Demographics
NPI:1457341026
Name:PATEL, MINA A (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 WINDING LAKE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2659
Mailing Address - Country:US
Mailing Address - Phone:407-415-4145
Mailing Address - Fax:
Practice Address - Street 1:1825 N MILLS AVE
Practice Address - Street 2:LAKESIDE SIDE SURGERY CENTER
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-206-2375
Practice Address - Fax:407-206-2377
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063787207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258117500Medicaid
F70560Medicare UPIN
FL258117500Medicaid