MEDICARE: DR. ANKUR BHARAT PATEL D.O.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	2017043613	MO
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	DO 1611	AL
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	84015	GA

General Provider Information

NPI Number	:	1780971994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANKUR BHARAT PATEL D.O.

Provider Business Mailing Address
First Line	:	PO BOX 28415
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-2036
Country	:	US
Telephone Number	:	888-488-8289
Fax Number	:	502-919-9780

Provider Business Practice Location Address
First Line	:	601 BROAD ST SE STE B
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3718
Country	:	US
Telephone Number	:	678-971-4167
Fax Number	:	833-989-2501

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

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	05/25/2022

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