Basic Information
| Provider Information | |||||||||
| NPI: | 1528303799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | KAJALBEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15809 BAY VISTA DR | ||||||||
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| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347145061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524045838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2209 NORTH BLVD W | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338378903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636798000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9106464 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.