Provider Demographics
NPI:1265464622
Name:PATEL, AMISH R (DO MPH)
Entity Type:Individual
Prefix:DR
First Name:AMISH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 LONDON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1515
Mailing Address - Country:US
Mailing Address - Phone:937-578-4580
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:660 LONDON AVE STE B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1515
Practice Address - Country:US
Practice Address - Phone:937-578-4580
Practice Address - Fax:937-578-4585
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008047208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2666404Medicaid
OH2666404Medicaid