Provider Demographics
NPI:1154328219
Name:PATEL, HANSA N (MD)
Entity Type:Individual
Prefix:
First Name:HANSA
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2713
Mailing Address - Country:US
Mailing Address - Phone:660-425-3154
Mailing Address - Fax:660-425-6663
Practice Address - Street 1:3202 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2713
Practice Address - Country:US
Practice Address - Phone:660-425-3154
Practice Address - Fax:660-425-6663
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8C10207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50538Medicare UPIN