Basic Information
| Provider Information | |||||||||
| NPI: | 1700982949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | MUKESH | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 SCOTT NIXON MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309072464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003944445 | ||||||||
| FaxNumber: | 7068684488 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 W DR MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | STE #310 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133507244 | ||||||||
| FaxNumber: | 8133507246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME63188 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.