Healthcare Provider Details

I. General information

NPI: 1013611094
Provider Name (Legal Business Name): VIVEK I. PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 S FLORIDA AVE STE 17
LAKELAND FL
33813-2182
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD ATTN: MANAGED CARE
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-646-5088
  • Fax:
Mailing address:
  • Phone: 863-687-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME176672
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME176672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: