Provider Demographics
NPI:1386958189
Name:PATEL, ASHISH C (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:C
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 1:20735 STERLINGTON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4390
Mailing Address - Country:US
Mailing Address - Phone:813-563-0751
Mailing Address - Fax:
Practice Address - Street 1:20735 STERLINGTON DR STE 102
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4390
Practice Address - Country:US
Practice Address - Phone:813-563-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09174700207Q00000X
390200000X
FLME121747207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014081900Medicaid
FLHZ633ZMedicare PIN