Provider Demographics
NPI:1285684563
Name:PATIL, ARUN-ANGELO (MD)
Entity Type:Individual
Prefix:
First Name:ARUN-ANGELO
Middle Name:
Last Name:PATIL
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 1:400 10TH ST E
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:888-209-0305
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:2900 ELK LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-8691
Practice Address - Country:US
Practice Address - Phone:888-209-0305
Practice Address - Fax:952-442-3620
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17562207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557581Medicaid
NE265791Medicare ID - Type Unspecified
NE47078557581Medicaid