Provider Demographics
NPI:1871590125
Name:PATIL, HARISH M (MD)
Entity type:Individual
Prefix:DR
First Name:HARISH
Middle Name:M
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:483 N SEMORAN BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-645-1847
Mailing Address - Fax:321-274-0322
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-645-1847
Practice Address - Fax:321-274-0322
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME90558207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46076OtherBCBS OF FL PROV ID #
FLP00142235OtherRAILROAD MEDICARE
P00662309OtherRAILROAD MEDICARE ATTACHED TO GROUP CH7618
FL267166OtherAMERIGROUP MCD PROV ID #
FL9925439OtherCIGNA PROV ID #
FL1106290OtherHUMANA PROV ID #
FL2473550OtherUNITED H'CARE PROV ID #
FL271142700Medicaid
P00662309OtherRAILROAD MEDICARE ATTACHED TO GROUP CH7618
FL2473550OtherUNITED H'CARE PROV ID #
FL46076WMedicare PIN