Basic Information
| Provider Information | |||||||||
| NPI: | 1649664640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLETTE | ||||||||
| FirstName: | KINJAL | ||||||||
| MiddleName: | PATEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 DAVIS BLVD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132502506 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7550 43RD ST N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337813601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132598725 | ||||||||
| FaxNumber: | 8132598792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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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 | 208000000X | ME135315 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.