Healthcare Provider Details

I. General information

NPI: 1770719510
Provider Name (Legal Business Name): ANUP PATEL MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N. ORANGE AVE SUITE 600
ORLANDO FL
32801
US

IV. Provider business mailing address

801 N. ORANGE AVE SUITE 600
ORLANDO FL
32801
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-2100
  • Fax: 407-841-5705
Mailing address:
  • Phone: 407-841-2100
  • Fax: 407-841-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME127383
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME127383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: