Provider Demographics
NPI:1275682221
Name:PATEL, ASHVIN A (MD)
Entity Type:Individual
Prefix:MR
First Name:ASHVIN
Middle Name:A
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 1:1051 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-720-1730
Mailing Address - Fax:810-720-1736
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-1730
Practice Address - Fax:810-720-1736
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063445207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30946OtherCOMMUNITY CHOICE OF MI
MI1172870001OtherTHE WELLNESS PLAN
MI252508OtherMCLAREN HEALTH ADVANTAG
MIEM033063OtherHEALTH ALLIANCE PLAN
MI567571OtherSELECT CARE
MIAP063345OtherSTATE LICENSE NUMBER
MI252508OtherMCLAREN HEALTH PLAN
MI050B56043OtherBLUE CROSSBLUE SHIELD
MI0996930OtherHEALTH PLUS OF MICHIGAN
MI104085OtherGREAT LAKES HEALTH PLAN
MI3475544Medicaid
MIG87551OtherAETNA HEALTH CARE
MIAN250004OtherM CARE INC
MIAP063345OtherSTATE LICENSE NUMBER
MI0B56043Medicare ID - Type Unspecified