Provider Demographics
NPI:1912944117
Name:PATEL, VISHNU (MD)
Entity Type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 202 C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3166
Mailing Address - Country:US
Mailing Address - Phone:321-728-2722
Mailing Address - Fax:321-435-3652
Practice Address - Street 1:910 MALABAR RD
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3200
Practice Address - Country:US
Practice Address - Phone:321-435-3655
Practice Address - Fax:321-435-3652
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME93611207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00264529OtherRAIL ROAD MEDICARE
FL274141500Medicaid
P00264529OtherRAIL ROAD MEDICARE
FLU5554YMedicare PIN