Provider Demographics
NPI:1235195561
Name:PATEL, KANDARP B (MD)
Entity Type:Individual
Prefix:DR
First Name:KANDARP
Middle Name:B
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 1:86 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2038
Mailing Address - Country:US
Mailing Address - Phone:731-300-0227
Mailing Address - Fax:731-300-0230
Practice Address - Street 1:86 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2038
Practice Address - Country:US
Practice Address - Phone:731-300-0227
Practice Address - Fax:731-300-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3845500Medicaid
TN165542OtherUNISON HEALTH PLAN
TN4294545OtherBLUE CROSS
TNHO4662Medicare UPIN
TN3845500Medicaid
TN165542OtherUNISON HEALTH PLAN