Provider Demographics
NPI:1073695631
Name:PATEL, VIVEK R (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2429 ASTARITA WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4464
Mailing Address - Country:US
Mailing Address - Phone:859-263-3648
Mailing Address - Fax:
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-9775
Practice Address - Country:US
Practice Address - Phone:859-858-2814
Practice Address - Fax:859-858-4039
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH51176Medicare UPIN