Provider Demographics
NPI:1700041316
Name:MAHESH PATEL MDPA
Entity Type:Organization
Organization Name:MAHESH PATEL MDPA
Other - Org Name:MAHESH PATEL MDPA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:813-224-9025
Mailing Address - Street 1:403 E. MARTIN LUTHER KING JR. BLVD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3805
Mailing Address - Country:US
Mailing Address - Phone:813-224-9025
Mailing Address - Fax:813-223-1545
Practice Address - Street 1:403 E. MARTIN LUTHER KING JR. BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3805
Practice Address - Country:US
Practice Address - Phone:813-224-9025
Practice Address - Fax:813-223-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045905400Medicaid
FL045905400Medicaid
FL02980Medicare PIN