Provider Demographics
NPI:1437492394
Name:PATHAK, VISHESH KUMAR (DO)
Entity type:Individual
Prefix:DR
First Name:VISHESH
Middle Name:KUMAR
Last Name:PATHAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5301 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1149
Mailing Address - Country:US
Mailing Address - Phone:561-548-1273
Mailing Address - Fax:561-548-1572
Practice Address - Street 1:180 JFK DR STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6607
Practice Address - Country:US
Practice Address - Phone:561-548-1450
Practice Address - Fax:561-548-1459
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS13985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program