Healthcare Provider Details

I. General information

NPI: 1891785119
Provider Name (Legal Business Name): VIPIN P. POPAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 TURKEY LAKE RD MP 452
ORLANDO FL
32819-8001
US

IV. Provider business mailing address

9400 TURKEY LAKE RD MP 452
ORLANDO FL
32819-8001
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5500
  • Fax: 321-843-5550
Mailing address:
  • Phone: 321-843-5500
  • Fax: 321-843-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME58760
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME58760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: