Provider Demographics
NPI:1649613217
Name:PATEL, TANMAY AMRUTLAL (MD)
Entity type:Individual
Prefix:DR
First Name:TANMAY
Middle Name:AMRUTLAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TANMAYKUMAR
Other - Middle Name:AMRUTLAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4195 US HIGHWAY 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5385
Mailing Address - Country:US
Mailing Address - Phone:321-405-2090
Mailing Address - Fax:888-849-6158
Practice Address - Street 1:4340 S HOPKINS AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6689
Practice Address - Country:US
Practice Address - Phone:321-222-3607
Practice Address - Fax:888-849-6158
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115718207R00000X, 207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHK002SOtherFL HFMG MEDICARE
FL009024800Medicaid
FL009024800Medicaid
FLHK002Medicare PIN