Provider Demographics
NPI:1346404761
Name:PATEL, MANISH N (MD)
Entity type:Individual
Prefix:
First Name:MANISH
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2627 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4712
Mailing Address - Country:US
Mailing Address - Phone:904-308-7372
Mailing Address - Fax:904-308-2908
Practice Address - Street 1:1710 N RANDALL RD STE 200
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9402
Practice Address - Country:US
Practice Address - Phone:847-214-5740
Practice Address - Fax:847-214-5777
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2021-12-16
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Provider Licenses
StateLicense IDTaxonomies
FLTRN 13003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine