Provider Demographics
NPI:1326655630
Name:PATEL, PARTH ANANTBHAI (MD)
Entity Type:Individual
Prefix:
First Name:PARTH
Middle Name:ANANTBHAI
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 1:6188 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7819
Mailing Address - Country:US
Mailing Address - Phone:810-813-1351
Mailing Address - Fax:
Practice Address - Street 1:12404 LIMA CROSSING DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-0202
Practice Address - Country:US
Practice Address - Phone:260-478-4201
Practice Address - Fax:260-619-5091
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351047308207Q00000X
IN01092582A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty