Provider Demographics
NPI:1548728033
Name:PATEL, PALAK
Entity type:Individual
Prefix:
First Name:PALAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 LADUE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2080
Mailing Address - Country:US
Mailing Address - Phone:314-367-1181
Mailing Address - Fax:314-968-5117
Practice Address - Street 1:11169 TRINITY BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4538
Practice Address - Country:US
Practice Address - Phone:727-877-0297
Practice Address - Fax:727-877-0312
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME171631207W00000X
MO2023011012207WX0107X
IL036164218207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2023011012OtherMEDICAL LICENSE
IL036-164218OtherMEDICAL LICENSE
FLME171631OtherMEDICAL LICENSE