Provider Demographics
NPI:1841272093
Name:PATEL, CHETAN K (MD)
Entity type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 E ALTAMONTE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4806
Mailing Address - Country:US
Mailing Address - Phone:407-303-5452
Mailing Address - Fax:407-303-5448
Practice Address - Street 1:711 E ALTAMONTE DR
Practice Address - Street 2:STE 210
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4806
Practice Address - Country:US
Practice Address - Phone:407-303-5452
Practice Address - Fax:407-303-5448
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105726207XS0117X, 207X00000X
MI4301067694207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0767220001OtherADMINISTAR FEDERAL
MI0F31114OtherBCBS
MI4570593Medicaid
MI0F33583OtherBCBS DME
H07896Medicare UPIN
MI0F31114OtherBCBS