Provider Demographics
NPI:1124136676
Name:PATEL, VIJAY MANUBHAI (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:MANUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17936 CACHET ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2702
Mailing Address - Country:US
Mailing Address - Phone:813-618-0034
Mailing Address - Fax:
Practice Address - Street 1:17936 CACHET ISLE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2702
Practice Address - Country:US
Practice Address - Phone:813-618-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78383207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390007237OtherRR MEDICARE
FL256744000Medicaid
FL46815X - TPAMedicare PIN
FL256744000Medicaid
FL46815Y - ZHMedicare PIN