MEDICARE: DR. JESAL V POPAT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	ME 117725	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RI0011X	Interventional Cardiology Physician	117725	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215256920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESAL V POPAT MD

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:	813-280-7300
Fax Number	:	813-377-1396

Provider Business Practice Location Address
First Line	:	14320 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2601
Country	:	US
Telephone Number	:	813-280-7300
Fax Number	:	813-377-1396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	08/27/2021

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