Healthcare Provider Details

I. General information

NPI: 1629473822
Provider Name (Legal Business Name): VK MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 PARK AVE
ORANGE PARK FL
32073-4152
US

IV. Provider business mailing address

1218 PARK AVE
ORANGE PARK FL
32073-4152
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberHCC10219
License Number StateFL

VIII. Authorized Official

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