Healthcare Provider Details

I. General information

NPI: 1629496484
Provider Name (Legal Business Name): AGAM PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 CRESTOVER LN
WESLEY CHAPEL FL
33544-6470
US

IV. Provider business mailing address

2344 CRESTOVER LN
WESLEY CHAPEL FL
33544-6470
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-0917
  • Fax: 727-220-5918
Mailing address:
  • Phone: 813-563-0917
  • Fax: 727-220-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME151100
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0072051
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME151100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: