Provider Demographics
NPI:1124022082
Name:PATEL, PANKAJ A (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:17501 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1589
Mailing Address - Country:US
Mailing Address - Phone:574-234-0049
Mailing Address - Fax:574-251-2861
Practice Address - Street 1:17501 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1589
Practice Address - Country:US
Practice Address - Phone:574-234-0049
Practice Address - Fax:574-251-2861
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049700A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7580376OtherAETNA
IN000000225361OtherBCBS
IN0649925002OtherCIGNA
IN200377140AMedicaid
IN100016227OtherRAILROAD MEDICARE
IN736980FMedicare PIN
IN200377140AMedicaid