Provider Demographics
NPI:1073877205
Name:PATEL, KRUTI (MD)
Entity Type:Individual
Prefix:
First Name:KRUTI
Middle Name:
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-586-8200
Mailing Address - Fax:859-586-8233
Practice Address - Street 1:6159 1ST FINANCIAL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7892
Practice Address - Country:US
Practice Address - Phone:859-586-8200
Practice Address - Fax:859-586-8233
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100308080Medicaid
KYK149090Medicare PIN