Healthcare Provider Details

I. General information

NPI: 1346014164
Provider Name (Legal Business Name): VK MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 EDGEWOOD AVE W STE 1
JACKSONVILLE FL
32208-3260
US

IV. Provider business mailing address

9250 CYPRESS GREEN DR
JACKSONVILLE FL
32256-1885
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-2437
  • Fax:
Mailing address:
  • Phone: 904-269-2437
  • Fax: 904-264-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRESH SUBHASH PATEL
Title or Position: CEO
Credential:
Phone: 904-269-2437