Provider Demographics
NPI:1093366346
Name:PATEL, BHAVMIK (PA-C)
Entity Type:Individual
Prefix:
First Name:BHAVMIK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3600 KOLBE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-960-3954
Mailing Address - Fax:440-960-3956
Practice Address - Street 1:3600 KOLBE RD STE 106
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-960-3954
Practice Address - Fax:440-960-3956
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.006349RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant