Provider Demographics
NPI:1316208093
Name:PATEL, AMIT BHAGWANJI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:BHAGWANJI
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:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-1060
Mailing Address - Country:US
Mailing Address - Phone:662-622-7011
Mailing Address - Fax:662-622-0257
Practice Address - Street 1:423 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618
Practice Address - Country:US
Practice Address - Phone:662-622-7011
Practice Address - Fax:662-622-0257
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24632207P00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program