Healthcare Provider Details

I. General information

NPI: 1255334959
Provider Name (Legal Business Name): KIRAN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 NORTH CLYDE MORRIS BL HALIFAX HEALTH MEDICAL CENTER
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

303 NORTH CLYDE MORRIS BL HALIFAX HEALTH MEDICAL CENTER
DAYTONA BEACH FL
32114-2709
US

V. Phone/Fax

Practice location:
  • Phone: 386-238-2285
  • Fax: 386-425-1304
Mailing address:
  • Phone: 386-238-2285
  • Fax: 386-425-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.37626
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: