Provider Demographics
NPI:1518252212
Name:PATEL, ROSHAN ASHOKKUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:ASHOKKUMAR
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 1:10000 W COLONIAL DR STE 394
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3433
Mailing Address - Country:US
Mailing Address - Phone:321-843-1378
Mailing Address - Fax:321-843-5177
Practice Address - Street 1:10000 W COLONIAL DR STE 394
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3433
Practice Address - Country:US
Practice Address - Phone:321-843-1378
Practice Address - Fax:321-843-5177
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135675207R00000X
NJ25MA09646900207RC0200X
NC201501524207RC0200X
FLME126966207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME126966OtherMEDICAL LICENSE
FL017832700Medicaid
FLIQ012ZMedicare PIN