Provider Demographics
NPI:1053489500
Name:PATEL, KISHOR K (MD)
Entity Type:Individual
Prefix:
First Name:KISHOR
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:VA ANN ARBOR HEALTHCARE SYSTEM
Mailing Address - Street 2:2215 FULLER ROAD
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-845-5290
Mailing Address - Fax:734-845-5288
Practice Address - Street 1:VA ANN ARBOR HEALTHCARE SYSTEM
Practice Address - Street 2:2215 FULLER ROAD
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-845-5290
Practice Address - Fax:734-845-5288
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-07-27
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI062185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262220OtherBLUE CROSS-BLUE CROSS
MI318900610Medicaid
KP062185OtherCHAMPUS-CHAMPUS
KP062185OtherCOMMERCIAL-COMMERCIAL NUMBER