Provider Demographics
NPI:1013995794
Name:PATIL, RAHUL DUNDAPPA (MD)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:DUNDAPPA
Last Name:PATIL
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 1:245 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2254
Mailing Address - Country:US
Mailing Address - Phone:850-469-7406
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-469-7406
Practice Address - Fax:850-478-1312
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107234208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193955Medicaid
0402114OtherUNITED HEALTHCARE
110218237OtherRRD MEDICARE
SC611371072OtherTRICARE
CO611371072OtherCHAMPVA
FL1491ZOtherBCBSFL
CT5179116OtherAETNA
OH611371072OtherOHIO HEALTH CHOICE
OH000000190734OtherANTHEM BCBS
OH0193955OtherMOLINA
CO611371072OtherBENESIGHT
OH000000207287OtherUNISON
FL002445400Medicaid
CT611371072OtherCIGNA
OH611371072OtherOHIO OPERATING ENGINEERS
OH611371072026OtherCARESOURCE
KY64030604Medicaid
CT5179116OtherAETNA
0402114OtherUNITED HEALTHCARE
FL1491ZOtherBCBSFL
OH0193955Medicaid