Provider Demographics
NPI:1649350281
Name:SAURABH N PATEL MD PA
Entity type:Organization
Organization Name:SAURABH N PATEL MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SAURABH
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-390-3339
Mailing Address - Street 1:27160 BAY LANDING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4301
Mailing Address - Country:US
Mailing Address - Phone:239-390-3339
Mailing Address - Fax:239-390-0445
Practice Address - Street 1:27160 BAY LANDING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4333
Practice Address - Country:US
Practice Address - Phone:239-390-3339
Practice Address - Fax:239-390-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90577207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP7781OtherSUBMITTER NUMBER
FLH97314Medicare UPIN
FLQ0327Medicare PIN