Provider Demographics
NPI:1023377918
Name:PATEL, PULAK DILIPKUMAR
Entity Type:Individual
Prefix:
First Name:PULAK
Middle Name:DILIPKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 PARK RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10650 PARK RD
Practice Address - Street 2:SUITE 420
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8538
Practice Address - Country:US
Practice Address - Phone:704-302-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01299207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC182594OtherRESIDENT TRAINING LICENSE
NCAC5385578-R824OtherDEA
SCNC2495Medicaid
NC1023377918Medicaid
NC182594OtherRESIDENT TRAINING LICENSE
NC1023377918Medicaid
NCNCP291CMedicare PIN
NCNCP291DMedicare PIN