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General NPI Number Information
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NPI Number | 1528556917
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Entity Type | Individual
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Provider Name | ISHAN SURESHCHANDRA PATEL MBBS
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Gender | Male
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2 SHIRCLIFF WAY MARY VIRGINIA TERRY CANCER CENTER
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-388-2619
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Fax | 904-739-7779
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Provider Business Mailing Address
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Address Line | 7751 BELFORT PKWY STE 350
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6951
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Country | US
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Telephone | 904-363-7453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101275365
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD-48597
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD-48597
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME173936
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License Number State | FL
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