Provider Demographics
NPI:1073619888
Name:PATIL, VIJAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:R
Last Name:PATIL
Suffix:
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 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-522-3355
Mailing Address - Fax:865-522-9774
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-522-3355
Practice Address - Fax:865-522-9774
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13138208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3161878Medicaid
TN13955OtherBCBS TN
TN3161878Medicaid
TN13955OtherBCBS TN
TN620997531OtherTAX ID NUMBER ALL CLAIMS
TN406332082Medicare UPIN