Basic Information
| Provider Information | |||||||||
| NPI: | 1427071737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NIMESH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15215 CORTEZ BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346136072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13944 LAKESHORE BLVD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346671431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278691782 | ||||||||
| FaxNumber: | 7278694720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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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 | 213E00000X | PO3211 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0000X | PO3211 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0103X | PO3211 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.