Provider Demographics
NPI:1386741890
Name:PATEL, BACHU C (MD)
Entity type:Individual
Prefix:
First Name:BACHU
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 W HIBISCUS BLVD # 401
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3044
Mailing Address - Country:US
Mailing Address - Phone:321-794-8547
Mailing Address - Fax:321-610-1805
Practice Address - Street 1:469 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6857
Practice Address - Country:US
Practice Address - Phone:321-254-2321
Practice Address - Fax:321-254-2011
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME44043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069835100Medicaid
FL05523Medicare ID - Type Unspecified
FL069835100Medicaid