Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036116703 | IL |
NPI | 1124079918 |
---|---|
Provider Name | Mayank Rajanikant Patel |
First Address | Orlando, FL 32891-8025 |
Second Address | Gainesville, FL 32610-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036116703 | LICENSE (01) | IL |
0361167031 | (05) | IL |
2006025324 | LICENSE (01) | MO |
206651606 | (05) | MO |
281405600 | (05) | FL |
546190 | MEDICARE GROUP (01) | IL |
I49128 | (02) | IL |