Provider Demographics
NPI:1992071047
Name:PATEL, CHETAN JITENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:JITENDRA
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 1:12601 NARCOOSSEE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6923
Mailing Address - Country:US
Mailing Address - Phone:407-605-3777
Mailing Address - Fax:321-473-4839
Practice Address - Street 1:12601 NARCOOSSEE RD STE 209
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832
Practice Address - Country:US
Practice Address - Phone:407-605-3777
Practice Address - Fax:321-473-4839
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133810208600000X
AL35910208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024408800Medicaid