=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801451208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIKESH AMIT PATEL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2019
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1865 NIGHTINGALE LN STE A
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-385-7718
-----------------------------------------------------
Fax | 352-385-7718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1865 NIGHTINGALE LN STE A
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-385-7718
-----------------------------------------------------
Fax | 352-385-7718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO4245
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------