MEDICARE: PAVANKUMAR PATEL 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	MD449832	PA
2	207R00000X	Internal Medicine Physician	01069508A	IN
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME166782	FL
4	207R00000X	Internal Medicine Physician	MD449832	PA

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	:	1407004708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAVANKUMAR PATEL MD

Provider Business Mailing Address
First Line	:	PO BOX 361095
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32936-1095
Country	:	US
Telephone Number	:	321-253-2900
Fax Number	:	321-435-0100

Provider Business Practice Location Address
First Line	:	5200 BABCOCK ST NE STE 106A
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4639
Country	:	US
Telephone Number	:	321-373-7700
Fax Number	:	321-256-5512

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

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	10/31/2025

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Directions to “ PAVANKUMAR PATEL MD” Practice Location

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