Provider Demographics
NPI:1912923079
Name:PATEL, NIRAL (MD)
Entity Type:Individual
Prefix:
First Name:NIRAL
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:407-876-2273
Mailing Address - Fax:407-347-3950
Practice Address - Street 1:11600 LAKESIDE VILLAGE LANE
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786
Practice Address - Country:US
Practice Address - Phone:407-876-2273
Practice Address - Fax:407-347-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115718207R00000X
FLME106053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-115718OtherSTATE LICENSE
FLME106053OtherFLORIDA LICENSE
IL036115718Medicaid
FLM7254OtherFL HF MEDICARE
I57240Medicare UPIN