Healthcare Provider Details

I. General information

NPI: 1952620544
Provider Name (Legal Business Name): MONALI HANMANT PATIL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2010
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

1875 NW CORPORATE BLVD STE 270
BOCA RATON FL
33431-8550
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6030
  • Fax:
Mailing address:
  • Phone: 561-997-0821
  • Fax: 561-997-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE-11813
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number99756
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME126843
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE-11813
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: