Provider Demographics
NPI:1003814146
Name:PATEL, KETAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KETAN
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 815639
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-5639
Mailing Address - Country:US
Mailing Address - Phone:972-888-7240
Mailing Address - Fax:972-888-7285
Practice Address - Street 1:4325 N JOSEY LN STE 202
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4637
Practice Address - Country:US
Practice Address - Phone:214-566-9616
Practice Address - Fax:307-459-6599
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL7098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162634302Medicaid
TX8B9713Medicare ID - Type UnspecifiedMEDICARE NUMBER
TX162634302Medicaid