Basic Information
| Provider Information | |||||||||
| NPI: | 1033374822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | KAUSHIKKUMAR | ||||||||
| MiddleName: | KANTILAL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 CENTURY MEDICAL DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327962100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212686264 | ||||||||
| FaxNumber: | 3212686360 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 N WASHINGTON AVE | ||||||||
| Address2: | PARRISH MEDICAL GROUP. HOSPITALIST DEPT | ||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327962163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212686111 | ||||||||
| FaxNumber: | 3212686360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20319 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 20319 | MS | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | ME118540 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | ME118540 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 06452802 | 05 | MS | MEDICAID | 010870200 | 05 | FL | MEDICAID |