MEDICARE: NARESH PATHAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0055176	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528043601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARESH PATHAK MD

Provider Business Mailing Address
First Line	:	7471 W OAKLAND PARK BLVD
Second Line	:	SUITE 110
City	:	LAUDERHILL
State	:	FL
Zip	:	33319
Country	:	US
Telephone Number	:	954-748-6175
Fax Number	:	954-748-2072

Provider Business Practice Location Address
First Line	:	7471 W OAKLAND PARK BLVD
Second Line	:	SUITE 110
City	:	LAUDERHILL
State	:	FL
Zip	:	33319
Country	:	US
Telephone Number	:	954-748-6175
Fax Number	:	954-748-2072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	07/24/2014

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