Healthcare Provider Details

I. General information

NPI: 1932686755
Provider Name (Legal Business Name): ALEXANDER KIRAN PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SOUTH ANDREWS AVENUE GRADUATE MEDICAL EDUCATION OFFICE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

520 SE 5TH AVE APT 2408
FORT LAUDERDALE FL
33301-2957
US

V. Phone/Fax

Practice location:
  • Phone: 954-459-2091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6077
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS17573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: