Provider Demographics
NPI:1053635045
Name:PATEL, SHRUTI HITENDRABHAI (MD)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:HITENDRABHAI
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 1:77 W ELMWOOD DR STE 211
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4263
Mailing Address - Country:US
Mailing Address - Phone:937-572-7648
Mailing Address - Fax:937-832-8279
Practice Address - Street 1:33 W RAHN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2219
Practice Address - Country:US
Practice Address - Phone:937-433-8990
Practice Address - Fax:937-832-8279
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121716207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088147Medicaid
OHH513350OtherMEDICARE PTAN