Provider Demographics
NPI:1891965844
Name:PATEL, PRITESH K (MD)
Entity type:Individual
Prefix:
First Name:PRITESH
Middle Name:K
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 JADE LOOP
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5134
Mailing Address - Country:US
Mailing Address - Phone:404-936-7224
Mailing Address - Fax:
Practice Address - Street 1:4236 JADE LOOP
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5134
Practice Address - Country:US
Practice Address - Phone:404-936-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD33863208100000X
FLME114505208100000X
MI4301095401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation