Provider Demographics
NPI:1295825685
Name:PATEL, SAMIRAN D (MD)
Entity Type:Individual
Prefix:
First Name:SAMIRAN
Middle Name:D
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 1:500 NW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-2455
Mailing Address - Country:US
Mailing Address - Phone:816-420-6368
Mailing Address - Fax:816-420-6320
Practice Address - Street 1:500 NW 68TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-2455
Practice Address - Country:US
Practice Address - Phone:816-420-6368
Practice Address - Fax:816-420-6320
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36919207R00000X
MO2009007667207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206424707Medicaid
I51074Medicare UPIN
MO1295825685Medicare PIN
AZZ120027Medicare PIN