Healthcare Provider Details

I. General information

NPI: 1417990524
Provider Name (Legal Business Name): KAMLESH P PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 IMAR DR
SUN CITY CENTER FL
33573-5368
US

IV. Provider business mailing address

PO BOX 5530
SUN CITY CENTER FL
33571-5530
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-3500
  • Fax: 813-634-4900
Mailing address:
  • Phone: 813-634-3500
  • Fax: 813-634-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME95909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: