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NPI Code Detail

MEDICARE: MRS. KOMAL J PATEL PA-C

MEDICARE: MRS. KOMAL J PATEL PA-C
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
1363AM0700XMedical Physician Assistant085.005429IL
2363A00000XPhysician AssistantPA9109395FL

Other Identifiers

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

General Provider Information

NPI Number : 1558758466
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KOMAL J PATEL PA-C
Provider Business Mailing Address
First Line : 5228 FALLEN LEAF DR
Second Line :
City : RIVERVIEW
State : FL
Zip : 33578-4740
Country : US
Telephone Number : 734-560-0756
Fax Number :
Provider Business Practice Location Address
First Line : 3345 S DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33629-7817
Country : US
Telephone Number : 813-234-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2015
Last Update Date : 07/02/2025

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