Healthcare Provider Details

I. General information

NPI: 1558929075
Provider Name (Legal Business Name): RISHI PATEL DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 5TH AVE N
SAINT PETERSBURG FL
33713-7218
US

IV. Provider business mailing address

5260 78TH AVE N UNIT 2616
PINELLAS PARK FL
33780-8106
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-6768
  • Fax: 727-327-8741
Mailing address:
  • Phone: 727-321-6768
  • Fax: 727-327-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RISHI PATEL
Title or Position: SELF
Credential: DO
Phone: 727-321-6768