MEDICARE: KAJALBEN PATEL

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	363A00000X	Physician Assistant	PA9106464	FL

General Provider Information

NPI Number	:	1528303799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAJALBEN PATEL

Provider Business Mailing Address
First Line	:	15809 BAY VISTA DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34714-5061
Country	:	US
Telephone Number	:	352-404-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 NORTH BLVD W
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8903
Country	:	US
Telephone Number	:	863-679-8000
Fax Number	:

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

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	11/29/2012

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Directions to “ KAJALBEN PATEL ” Practice Location

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