Healthcare Provider Details

I. General information

NPI: 1144668187
Provider Name (Legal Business Name): PATEL MEDICAL VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 LAKESIDE VILLAGE LN
WINDERMERE FL
34786-7024
US

IV. Provider business mailing address

11600 LAKESIDE VILLAGE LN
WINDERMERE FL
34786-7024
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-2273
  • Fax: 407-347-3950
Mailing address:
  • Phone: 407-876-2273
  • Fax: 407-347-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9253662
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 71809
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 90801
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME106053
License Number StateFL

VIII. Authorized Official

Name: DR. NIRAL CHANDRAKANT PATEL
Title or Position: MANAGER
Credential: M.D
Phone: 407-876-2273