Provider Demographics
NPI:1144668187
Name:PATEL MEDICAL VENTURES LLC
Entity type:Organization
Organization Name:PATEL MEDICAL VENTURES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAL
Authorized Official - Middle Name:CHANDRAKANT
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-876-2273
Mailing Address - Street 1:11600 LAKESIDE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7024
Mailing Address - Country:US
Mailing Address - Phone:407-876-2273
Mailing Address - Fax:407-347-3950
Practice Address - Street 1:11600 LAKESIDE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7024
Practice Address - Country:US
Practice Address - Phone:407-876-2273
Practice Address - Fax:407-347-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDC009942111N00000X
FL9253662363LF0000X
FLME 71809208000000X
FLME 90801208000000X
FLME106053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty