Provider Demographics
NPI:1427071737
Name:PATEL, NIMESH M (DPM)
Entity type:Individual
Prefix:
First Name:NIMESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6072
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:
Practice Address - Street 1:13944 LAKESHORE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1431
Practice Address - Country:US
Practice Address - Phone:727-869-1782
Practice Address - Fax:727-869-4720
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3211213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5108ZMedicare ID - Type Unspecified
V05758Medicare UPIN