MEDICARE: DHIRAJ B PATEL M.D.

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	207R00000X	Internal Medicine Physician	ME0040172	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	:	1710938527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHIRAJ B PATEL M.D.

Provider Business Mailing Address
First Line	:	3109 STIRLING ROAD
Second Line	:	SUITE 106
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	954-963-4112
Fax Number	:	954-962-4779

Provider Business Practice Location Address
First Line	:	3109 STIRLING ROAD
Second Line	:	SUITE 106
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	954-963-4112
Fax Number	:	954-962-4779

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/06/2010

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