Provider Demographics
NPI:1902870819
Name:PATEL, CHIRAG N (MD)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11373 CORTEZ BLVD.
Mailing Address - Street 2:#206
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5405
Mailing Address - Country:US
Mailing Address - Phone:352-596-3032
Mailing Address - Fax:352-596-3066
Practice Address - Street 1:13906 LAKESHORE BLVD
Practice Address - Street 2:#330
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1487
Practice Address - Country:US
Practice Address - Phone:727-863-7766
Practice Address - Fax:727-862-8510
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269225200Medicaid
K5936Medicare PIN
FL269225200Medicaid