Healthcare Provider Details

I. General information

NPI: 1013619642
Provider Name (Legal Business Name): KUNAL PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

11418 GULLWOOD DR
HOUSTON TX
77089-6818
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2005
  • Fax:
Mailing address:
  • Phone: 281-808-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: