Provider Demographics
NPI:1023000668
Name:PATEL, INDU BABUBHAI (MD)
Entity Type:Individual
Prefix:MS
First Name:INDU
Middle Name:BABUBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 METROPOLITAN BLVD
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1495
Mailing Address - Country:US
Mailing Address - Phone:636-464-7032
Mailing Address - Fax:636-464-5877
Practice Address - Street 1:7105 METROPOLITAN BLVD
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1495
Practice Address - Country:US
Practice Address - Phone:636-464-7032
Practice Address - Fax:636-464-5877
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D52207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201974219Medicaid
MO201974219Medicaid
MOA11952Medicare UPIN