Provider Demographics
NPI:1316408081
Name:PATEL, DHARMIK (MD)
Entity Type:Individual
Prefix:
First Name:DHARMIK
Middle Name:
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 1:2901 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4329
Mailing Address - Country:US
Mailing Address - Phone:414-649-3323
Mailing Address - Fax:
Practice Address - Street 1:26908 DETROIT RD STE 103
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2399
Practice Address - Country:US
Practice Address - Phone:440-249-0274
Practice Address - Fax:440-808-1718
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
OH35.147640207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program