Provider Demographics
NPI:1457351322
Name:PATEL, BHARAT C (MD)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:C
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 1:7955 SPYGLASS HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8249
Mailing Address - Country:US
Mailing Address - Phone:321-255-6670
Mailing Address - Fax:321-242-2545
Practice Address - Street 1:7955 SPYGLASS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8249
Practice Address - Country:US
Practice Address - Phone:321-255-6670
Practice Address - Fax:321-242-2545
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93866204R00000X, 2081P2900X, 2081S0010X, 208VP0000X, 208VP0014X
FLME83866208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7067635OtherAETNA
11343100OtherCAQH
FLP00605601OtherMEDICARE RAILROAD CARRIER
FL01069OtherBC BS FL
FL7067635OtherAETNA
NYI20522Medicare UPIN