Provider Demographics
NPI:1053318956
Name:GAJERA & PATEL PLLC
Entity Type:Organization
Organization Name:GAJERA & PATEL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-885-0570
Mailing Address - Street 1:1717 HIGH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-885-0570
Mailing Address - Fax:270-885-0573
Practice Address - Street 1:1717 HIGH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-885-0570
Practice Address - Fax:270-885-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2018-08-02
Deactivation Date:2005-07-08
Deactivation Code:
Reactivation Date:2007-05-10
Provider Licenses
StateLicense IDTaxonomies
KY31906207RH0003X
KY22180207RX0202X
KY1073349363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64221807Medicaid
KY65941031Medicaid
KY78006533Medicaid
KY000000315811OtherANTHEM
KYP00076948OtherRAILROAD MEDICARE
KY64319064Medicaid
KY7961Medicare ID - Type Unspecified
KY64319064Medicaid
KY5361460001Medicare NSC
C74492Medicare UPIN