Provider Demographics
NPI:1073976965
Name:PATEL, KRUNALKUMAR
Entity Type:Individual
Prefix:
First Name:KRUNALKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5734
Mailing Address - Country:US
Mailing Address - Phone:734-483-1000
Mailing Address - Fax:734-483-1010
Practice Address - Street 1:340 ECORSE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5734
Practice Address - Country:US
Practice Address - Phone:734-483-1000
Practice Address - Fax:734-483-1010
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist