Healthcare Provider Details

I. General information

NPI: 1790466258
Provider Name (Legal Business Name): LIBERTY MED CONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29498 TORICELLI RD
WESLEY CHAPEL FL
33543-2248
US

IV. Provider business mailing address

29498 TORICELLI RD
WESLEY CHAPEL FL
33543-2248
US

V. Phone/Fax

Practice location:
  • Phone: 570-677-4001
  • Fax:
Mailing address:
  • Phone: 570-677-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEHUL SUMAN PATEL
Title or Position: OWNER
Credential: MD
Phone: 570-677-4001