Healthcare Provider Details

I. General information

NPI: 1770014052
Provider Name (Legal Business Name): SAGAR PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

11830 UPTOWN WALKER PL APT 217
THONOTOSASSA FL
33592-3987
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-6000
  • Fax:
Mailing address:
  • Phone: 727-637-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number146189
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME146189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: