Provider Demographics
NPI:1669546222
Name:PATEL, DEVANG BHASKARBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:DEVANG
Middle Name:BHASKARBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2518
Mailing Address - Country:US
Mailing Address - Phone:772-220-1919
Mailing Address - Fax:772-220-2335
Practice Address - Street 1:1100 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2518
Practice Address - Country:US
Practice Address - Phone:772-220-1919
Practice Address - Fax:772-220-2335
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48874207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035677800Medicaid
FLE31265Medicare UPIN
FL08379XMedicare ID - Type UnspecifiedPHYSICIAN