Provider Demographics
NPI:1164480687
Name:PATEL, DIPAKKUMAR SHANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPAKKUMAR
Middle Name:SHANTILAL
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 1:11312 OLD RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8338
Mailing Address - Country:US
Mailing Address - Phone:405-796-7234
Mailing Address - Fax:
Practice Address - Street 1:11312 OLD RIVER TRL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8338
Practice Address - Country:US
Practice Address - Phone:405-796-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24244207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001261817Medicaid
CTB39695Medicare UPIN
CT001261817Medicaid