Provider Demographics
NPI:1164867461
Name:PATEL-YADAV, AMI KANTI (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMI
Middle Name:KANTI
Last Name:PATEL-YADAV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:KANTI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1609 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6920
Practice Address - Country:US
Practice Address - Phone:817-359-9000
Practice Address - Fax:817-354-8969
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS77542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX418010101Medicaid