Provider Demographics
NPI:1093758187
Name:PATEL, ASHISH VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:VIJAY
Last Name:PATEL
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 1:12236 PATAGONIA LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1909
Mailing Address - Country:US
Mailing Address - Phone:423-943-3001
Mailing Address - Fax:
Practice Address - Street 1:269 CUSICK RD STE A
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-3192
Practice Address - Country:US
Practice Address - Phone:865-888-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109047207QA0401X
TN39013207QA0401X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936662Medicaid
TNP00297356OtherRAILROAD MEDICARE
TN3339540Medicaid
TN4150093OtherBLUE CROSS
TN4114001OtherBCBS OF TENNESSEE
GA591941960AMedicaid
TN3339549Medicaid
TN3339549Medicare PIN
TNI19022Medicare UPIN
TN3339540Medicare PIN
TN4150093OtherBLUE CROSS