Provider Demographics
NPI:1528166295
Name:PATEL, PRITESH (MD)
Entity type:Individual
Prefix:
First Name:PRITESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 340658
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694-0658
Mailing Address - Country:US
Mailing Address - Phone:727-375-8528
Mailing Address - Fax:727-372-1901
Practice Address - Street 1:18928 N DALE MABRY HWY
Practice Address - Street 2:STE 101
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4922
Practice Address - Country:US
Practice Address - Phone:813-909-1146
Practice Address - Fax:813-909-4334
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88796207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270574500Medicaid
FLI24038Medicare UPIN
FL49095YMedicare ID - Type Unspecified