Provider Demographics
NPI:1023198926
Name:PEDIATRIC SPECIALTY PHYSICIANS, PC
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY PHYSICIANS, PC
Other - Org Name:JAYESH P. PATEL, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-408-5801
Mailing Address - Street 1:7429 INVERNESS COMMONS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3837
Mailing Address - Country:US
Mailing Address - Phone:260-408-5801
Mailing Address - Fax:888-949-8258
Practice Address - Street 1:7429 INVERNESS COMMONS
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-3837
Practice Address - Country:US
Practice Address - Phone:260-408-5801
Practice Address - Fax:888-949-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200301280Medicaid