=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992071047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHETAN JITENDRA PATEL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2012
-----------------------------------------------------
Last Update Date | 10/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12601 NARCOOSSEE RD STE 209
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-605-3777
-----------------------------------------------------
Fax | 321-473-4839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12601 NARCOOSSEE RD STE 209
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32832-7144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-605-3777
-----------------------------------------------------
Fax | 321-473-4839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number | ME133810
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME133810
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------