MEDICARE: LIBERTY MEDICAL LLC

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

General Provider Information

NPI Number	:	1790466258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY MEDICAL LLC

Provider Business Mailing Address
First Line	:	29498 TORICELLI RD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-2248
Country	:	US
Telephone Number	:	570-677-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	29498 TORICELLI RD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-2248
Country	:	US
Telephone Number	:	570-677-4001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MEHUL SUMAN PATEL
Credential	:	MD
Telephone Number	:	570-677-4001

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	05/18/2026

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