Healthcare Provider Details

I. General information

NPI: 1679597512
Provider Name (Legal Business Name): RAJNIKANT C PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10616 MAIN ST
THONOTOSASSA FL
33592-2828
US

IV. Provider business mailing address

10616 MAIN ST
THONOTOSASSA FL
33592-2828
US

V. Phone/Fax

Practice location:
  • Phone: 813-986-1346
  • Fax: 813-986-6642
Mailing address:
  • Phone: 813-684-3222
  • Fax: 813-681-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 0088670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: