MEDICARE: MUKTI PATEL

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	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11044	OTHER	GA	GCMB
2	TPPA710	OTHER	FL	DOH FL

General Provider Information

NPI Number	:	1578207353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKTI PATEL

Provider Business Mailing Address
First Line	:	21 MAIN ST
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-1402
Country	:	US
Telephone Number	:	912-704-7045
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 2ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4313
Country	:	US
Telephone Number	:	347-830-7720
Fax Number	:

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

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	01/15/2026

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Directions to “ MUKTI PATEL ” Practice Location

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