Healthcare Provider Details

I. General information

NPI: 1043506025
Provider Name (Legal Business Name): MIKSHA PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD DEPT. OF PEDIATRICS AT SHANDS
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4190 NW 50TH DR APT 7310
GAINESVILLE FL
32606-4604
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: