Provider Demographics
NPI:1093884538
Name:PATEL, TUSHAR PRATAP (MD)
Entity Type:Individual
Prefix:DR
First Name:TUSHAR
Middle Name:PRATAP
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17150 EUCLID ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4092
Mailing Address - Country:US
Mailing Address - Phone:714-957-0317
Mailing Address - Fax:714-957-0616
Practice Address - Street 1:17150 EUCLID ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-957-0317
Practice Address - Fax:714-957-0616
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71957207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH40221Medicare UPIN