Provider Demographics
NPI:1225233133
Name:PATEL, PRANJALKUMAR H (MD)
Entity Type:Individual
Prefix:
First Name:PRANJALKUMAR
Middle Name:H
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 1:1530 BESSIE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3080
Mailing Address - Country:US
Mailing Address - Phone:209-836-3967
Mailing Address - Fax:209-836-0626
Practice Address - Street 1:1530 BESSIE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3080
Practice Address - Country:US
Practice Address - Phone:209-836-3967
Practice Address - Fax:209-836-0626
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200924520Medicaid
IN252000QMedicare PIN
IN200924520Medicaid
CAA116600Medicare PIN