Healthcare Provider Details

I. General information

NPI: 1588875819
Provider Name (Legal Business Name): RISHI R PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17222 HOSPITAL BLVD SUITE 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: 352-796-3323
Mailing address:
  • Phone: 352-796-3334
  • Fax: 352-796-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101258312
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number248030
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0076460
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0124368
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number57.011035
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number248030
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number248030
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD0076460
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number0101258312
License Number StateVA
# 10
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME0124368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: