Provider Demographics
NPI:1013005412
Name:PATEL, VIPUL RAMANBHAI (DPM)
Entity Type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:RAMANBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 ADAM SHEPHERD PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6640
Mailing Address - Country:US
Mailing Address - Phone:502-543-1553
Mailing Address - Fax:502-543-1558
Practice Address - Street 1:421 ADAM SHEPHERD PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6640
Practice Address - Country:US
Practice Address - Phone:502-543-1553
Practice Address - Fax:502-543-1558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00331213E00000X, 213ES0103X, 213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000783180OtherANTHEM
KY7100059570Medicaid
KY9673151OtherAETNA
KY50043984OtherPASSPORT
KYP01098974OtherRR MEDICARE
KY50043984OtherPASSPORT