MEDICARE: ASHISHKUMAR PATEL 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	208000000X	Pediatrics Physician	ME138415	FL
2	2080P0202X	Pediatric Cardiology Physician	ME138415	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770973075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHISHKUMAR PATEL MD

Provider Business Mailing Address
First Line	:	6100 GREENLAND RD STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2626
Country	:	US
Telephone Number	:	904-257-6264
Fax Number	:	904-293-1326

Provider Business Practice Location Address
First Line	:	6100 GREENLAND RD
Second Line	:	STE 301
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2626
Country	:	US
Telephone Number	:	904-257-6264
Fax Number	:	904-293-1326

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

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	08/18/2020

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