Provider Demographics
NPI:1114901105
Name:PATEL, ATULKUMAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:ATULKUMAR
Middle Name:N
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 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1053
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9417
Practice Address - Country:US
Practice Address - Phone:414-761-2600
Practice Address - Fax:414-761-2620
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30033-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31752500Medicaid
P00078323OtherRAIL ROAD MEDICARE
P00078323OtherRAIL ROAD MEDICARE
WI0013-68670Medicare ID - Type UnspecifiedPROVIDER NUMBER
WIE86694Medicare UPIN