Provider Demographics
NPI:1912058561
Name:PATEL, VIMAL HARSHAD (MD)
Entity type:Individual
Prefix:
First Name:VIMAL
Middle Name:HARSHAD
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 1:10408 BRENTFORD DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1834
Mailing Address - Country:US
Mailing Address - Phone:407-739-7619
Mailing Address - Fax:
Practice Address - Street 1:10408 BRENTFORD DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1834
Practice Address - Country:US
Practice Address - Phone:407-739-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME915722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01603656OtherRR MEDICARE
FL271116800Medicaid
FL31128OtherBCBS
FL271116800Medicaid