=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578873170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCADIA GENERAL INTERNAL MEDICINE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2010
-----------------------------------------------------
Last Update Date | 10/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E GIBSON ST
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-494-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 E GIBSON ST
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-494-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MAHENDRAKUMAR A PATEL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 863-494-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME47370
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------