Provider Demographics
NPI:1235151705
Name:PATEL, SURESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:K
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 1:909 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249
Mailing Address - Country:US
Mailing Address - Phone:701-256-6100
Mailing Address - Fax:701-256-6156
Practice Address - Street 1:909 2ND ST
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2407
Practice Address - Country:US
Practice Address - Phone:701-256-6100
Practice Address - Fax:701-256-6156
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23445OtherBLUE CROSS/BLUE SHIELD
ND15973Medicaid
ND23445Medicare ID - Type Unspecified
ND23445OtherBLUE CROSS/BLUE SHIELD