Provider Demographics
NPI:1073613626
Name:PATEL, KISHOR I (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHOR
Middle Name:
Last Name:PATEL
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21851 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-9998
Mailing Address - Country:US
Mailing Address - Phone:440-333-5822
Mailing Address - Fax:440-333-5824
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-9998
Practice Address - Country:US
Practice Address - Phone:440-333-5822
Practice Address - Fax:440-333-5824
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59487207RG0300X
OH35059487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE76751Medicare UPIN