Provider Demographics
NPI:1770973075
Name:PATEL, ASHISHKUMAR (MD)
Entity type:Individual
Prefix:
First Name:ASHISHKUMAR
Middle Name:
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 1:6100 GREENLAND RD STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2626
Mailing Address - Country:US
Mailing Address - Phone:904-257-6264
Mailing Address - Fax:904-293-1326
Practice Address - Street 1:6100 GREENLAND RD
Practice Address - Street 2:STE 301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2626
Practice Address - Country:US
Practice Address - Phone:904-257-6264
Practice Address - Fax:904-293-1326
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138415208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102213100Medicaid
FL102515700Medicaid