Healthcare Provider Details

I. General information

NPI: 1003077652
Provider Name (Legal Business Name): UTPALKUMAR PATEL M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17222 HOSPITAL BLVD STE 346
BROOKSVILLE FL
34601-8925
US

IV. Provider business mailing address

17222 HOSPITAL BLVD STE 346
BROOKSVILLE FL
34601-8925
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax: 352-796-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME115939
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME115939
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME115939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: