Basic Information
| Provider Information | |||||||||
| NPI: | 1164675369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NAYANKUMAR | ||||||||
| MiddleName: | RAMESHBHAI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4171 LAKE NED VILLAGE CIR | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338842588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177991711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 N ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335634303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638165884 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2008 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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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 | 208M00000X | ME106355 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | ME106355 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002485700 | 05 | FL | MEDICAID |