Healthcare Provider Details

I. General information

NPI: 1245593987
Provider Name (Legal Business Name): PRAKRUT PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 101
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 101
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-891-2941
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-891-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME136480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: