Provider Demographics
NPI:1295773307
Name:PATEL, MIKSHA (MD)
Entity type:Individual
Prefix:
First Name:MIKSHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S OCEAN BLVD APT 1406
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6247
Mailing Address - Country:US
Mailing Address - Phone:516-639-7002
Mailing Address - Fax:
Practice Address - Street 1:BROWARD HEALTH NORTH
Practice Address - Street 2:201 E SAMPLE RD
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-941-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134845208100000X
NY167089208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01019992Medicaid
NY01019992Medicaid
B20466Medicare UPIN